Claim CLM-2026-9164
Patient
- Name
- Maya Feldman
- Date of birth
- 1971-12-11
- Patient id
- P009
Payer
- Name
- Humana
- Payer id code
- 61101
Provider
- Name
- Northside Medical
- NPI
- 1982744321
Service
- Date of service
- May 4 (denial date, no service date on file)
- Procedure
- 96417, Chemotherapy, Additional Sequential
- Diagnosis code
- C18.9
- Billed amount
- $13,490
Denial
- Reason
- Pre-Auth Missing, code 197
- Date
- May 4
Appeal
- Status
- No appeal filed yet
Prepared by Heron on Aug 30.