Leila Haddad

CLM-2026-9165, BCBS, Chemotherapy Infusion, 1st Hour (96413)

In reviewWith you Denied claims

Billed

$4,897

denied Jul 23

Denial risk

51%

good odds

Appeal window

52d

closes Oct 21

Appeals

none filed yet

What I did

and what comes next

Claim reached Heron
Posted from the 835 remittance
Jul 23
Denied by BCBS
Bundling/Coding Error (97)
Jul 23
Heron scored it: 51% denial risk
3 factors found, appeal path chosen
Jul 23
Appeal window closes
52 days left to file
Oct 21

The denial

Bundling/Coding Error, code 97

Patient: Leila Haddad, born 1964-12-23
Payer: BCBS
Procedure: Chemotherapy Infusion, 1st Hour (96413)
Diagnosis: C50.911
Denied on: Jul 23, 2026
Assigned to: Heron

Heron says

BCBS bundled this line into a primary procedure billed the same day. Modifier review recommended, most bundling denials resolve on corrected resubmission. Verify NCCI edit pairs before resubmitting to avoid a second rejection.

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What I sent

Corrected claim

Everything I know about Leila

across every queue

Everything for this patient

Open exposure

$31,647

Recovered

$7,415

4 denied claims1 prior auth4 underpayments7 backlog claims

AUTH-4018

96413 · Chemotherapy Infusion, 1st Hour

93306 · 3d outstanding

93306 · 3d outstanding

93000 · Medical Necessity

72110 · 29d outstanding

96417 · 37d outstanding

96413 · Bundling/Coding Error

96413 · Coverage Terminated

93015 · 44d outstanding

72110 · 64d outstanding

96417 · 102d outstanding

93000 · underpaid 23.1%

93306 · underpaid 6.7%

93015 · underpaid 17%

96413 · underpaid 24.4%

$626 short

Recovered

Sep 17