Claim CLM-2026-9153
Patient
- Name
- Teodora Petrova
- Date of birth
- 1983-03-24
- Patient id
- P048
Payer
- Name
- BCBS
- Payer id code
- 00210
Provider
- Name
- Northside Medical
- NPI
- 1982744321
Service
- Date of service
- Aug 18 (denial date, no service date on file)
- Procedure
- 97530, Therapeutic Activities, 15 min
- Diagnosis code
- M62.81
- Billed amount
- $1,236
Denial
- Reason
- Missing Information, code 16
- Date
- Aug 18
Appeal
- Status
- No appeal filed yet
Prepared by Heron on Aug 30.