Priya Raman

CLM-2026-9016, Medicare, Chemotherapy, Additional Sequential (96417)

In reviewWith you Denied claims

Billed

$10,427

denied Aug 22

Denial risk

41%

good odds

Appeal window

82d

closes Nov 20

Appeals

none filed yet

What I did

and what comes next

Claim reached Heron
Posted from the 835 remittance
Aug 22
Denied by Medicare
Missing Information (16)
Aug 22
Heron scored it: 41% denial risk
3 factors found, appeal path chosen
Aug 22
Appeal window closes
82 days left to file
Nov 20

The denial

Missing Information, code 16

Patient: Priya Raman, born 1955-06-04
Payer: Medicare
Procedure: Chemotherapy, Additional Sequential (96417)
Diagnosis: C18.9
Denied on: Aug 22, 2026
Assigned to: Heron

Heron says

Claim rejected for incomplete data, most often a missing referring provider NPI or member ID mismatch. Member ID on file (INS840674) should be revalidated against the payer's eligibility response. Corrected claims for this reason typically pay within 16 days.