Maya Feldman

CLM-2026-9164, Humana, Chemotherapy, Additional Sequential (96417)

RecoveredWith me Denied claims

Billed

$13,490

denied May 4

Denial risk

71%

winnable with the right notes

Appeal window

closed

nothing left to file

Recovered

$13,490

the money is back

What I did

and what comes next

Claim reached Heron
Posted from the 835 remittance
May 4
Denied by Humana
Pre-Auth Missing (197)
May 4
Heron scored it: 71% denial risk
3 factors found, appeal path chosen
May 4
Paid in full
The money is back
Jul 5

The denial

Pre-Auth Missing, code 197

Patient: Maya Feldman, born 1971-12-11
Payer: Humana
Procedure: Chemotherapy, Additional Sequential (96417)
Diagnosis: C18.9
Denied on: May 4, 2026
Assigned to: Heron

Appeal successful, payment posted

Heron says

Prior authorization was not on file at time of service, Humana auto-denies 96417 without it. 7 similar denials at this facility in the last 90 days for the same reason. Retro-auth may be available within 30 days of service; escalate to the payer's auth desk.