Hannah Kowalczyk

CLM-2026-9159, Medicare, MRI Lumbar Spine w/o Contrast (72148)

RecoveredWith me Denied claims

Billed

$3,448

denied Feb 25

Denial risk

50%

good odds

Appeal window

closed

nothing left to file

Recovered

$3,448

the money is back

What I did

and what comes next

Claim reached Heron
Posted from the 835 remittance
Feb 25
Denied by Medicare
Not Covered (96)
Feb 25
Heron scored it: 50% denial risk
3 factors found, appeal path chosen
Feb 25
Paid in full
The money is back
Apr 27

The denial

Not Covered, code 96

Patient: Hannah Kowalczyk, born 1955-05-10
Payer: Medicare
Procedure: MRI Lumbar Spine w/o Contrast (72148)
Diagnosis: M51.16
Denied on: Feb 25, 2026
Assigned to: Heron

Appeal successful, payment posted

Heron says

Service is excluded under the member's current Medicare benefit plan. Verify benefits as of the date of service, plan may have changed mid-year. If non-covered is confirmed, route to patient responsibility rather than appeal.

No appeal yet

I can draft one from this claim's history

View the claim form

This claim is settled, so there is nothing left to write.

What I sent

Nothing sent yet.

Everything I know about Hannah

across every queue

Everything for this patient

Open exposure

$17,932

Recovered

$16,371

8 denied claims2 prior auths0 underpayments3 backlog claims

AUTH-4057

73721 · MRI Lower Extremity Joint

70553 · MRI Brain w/ and w/o Contrast

93000 · Timely Filing

73721 · 74d outstanding

93306 · 134d outstanding

73721 · Medical Necessity

93000 · 181d outstanding

73721 · Missing Information

93306 · Medical Necessity

70553 · Pre-Auth Missing

73721 · Medical Necessity

72148 · Timely Filing

$2,698

Recovered

Dec 14