Claim CLM-2026-9168
Patient
- Name
- Ingrid Solberg
- Date of birth
- 1997-12-26
- Patient id
- P036
Payer
- Name
- UnitedHealthcare
- Payer id code
- 87726
Provider
- Name
- Northside Medical
- NPI
- 1982744321
Service
- Date of service
- May 25 (denial date, no service date on file)
- Procedure
- 93000, Electrocardiogram, Complete
- Diagnosis code
- R00.2
- Billed amount
- $2,494
Denial
- Reason
- Pre-Auth Missing, code 197
- Date
- May 25
Appeal
- Status
- No appeal filed yet
Prepared by Heron on Aug 30.