Elliot Marchetti

CLM-2026-9158, Aetna, MRI Lower Extremity Joint (73721)

In appealWith the payer Denied claims

Billed

$3,899

denied Jun 6

Denial risk

76%

a hard one, worth it

Appeal window

closes Sep 4

Appeals

none filed yet

What I did

and what comes next

Claim reached Heron
Imported from a CSV export
Jun 6
Denied by Aetna
Medical Necessity (50)
Jun 6
Heron scored it: 76% denial risk
3 factors found, appeal path chosen
Jun 6

The denial

Medical Necessity, code 50

Patient: Elliot Marchetti, born 1993-12-27
Payer: Aetna
Procedure: MRI Lower Extremity Joint (73721)
Diagnosis: M23.61
Denied on: Jun 6, 2026
Assigned to: Heron

Heron says

High recovery risk (76), prioritize this claim in the appeal queue. Aetna denies 43% of 73721 claims without documented conservative treatment. Clinical notes supporting medical necessity were not attached to the original submission.

No appeal yet

I can draft one from this claim's history

Draft it View the claim form

Open Intelligence, pick this claim, and I write the letter from the denial, the payer's rules and the clinical guideline. You sign it here.

What I sent

Clinical notes
Operative report

Everything I know about Elliot

across every queue

Everything for this patient

Open exposure

$44,591

Recovered

5 denied claims3 prior auths2 underpayments3 backlog claims

AUTH-4080

70553 · MRI Brain w/ and w/o Contrast

96417 · Chemotherapy, Additional Sequential

70553 · MRI Brain w/ and w/o Contrast

73721 · 11d outstanding

70553 · underpaid 33.1%

73721 · Medical Necessity

70553 · Duplicate Claim

93000 · 118d outstanding

93306 · 126d outstanding

96417 · Missing Information

70553 · underpaid 12.2%

72148 · Medical Necessity

$1,743

Written off

Jan 2