Claim CLM-2026-9154
Patient
- Name
- Jonah Weiss
- Date of birth
- 2005-05-15
- Patient id
- P029
Payer
- Name
- Cigna
- Payer id code
- 62308
Provider
- Name
- Northside Medical
- NPI
- 1982744321
Service
- Date of service
- Aug 4 (denial date, no service date on file)
- Procedure
- 96417, Chemotherapy, Additional Sequential
- Diagnosis code
- C18.9
- Billed amount
- $5,639
Denial
- Reason
- Medical Necessity, code 50
- Date
- Aug 4
Appeal
- Status
- No appeal filed yet
Prepared by Heron on Aug 30.