Claim CLM-2026-9163
Patient
- Name
- Simone Laurent
- Date of birth
- 1966-12-04
- Patient id
- P011
Payer
- Name
- UnitedHealthcare
- Payer id code
- 87726
Provider
- Name
- Northside Medical
- NPI
- 1982744321
Service
- Date of service
- Jun 5 (denial date, no service date on file)
- Procedure
- 70553, MRI Brain w/ and w/o Contrast
- Diagnosis code
- G43.909
- Billed amount
- $2,806
Denial
- Reason
- Medical Necessity, code 50
- Date
- Jun 5
Appeal
- Status
- No appeal filed yet
Prepared by Heron on Aug 30.