Heron

Sunita Bhatt

CLM-2026-9017, UnitedHealthcare, Chemotherapy, Additional Sequential (96417)

RecoveredWith me Denied claims
Billed
$15,685
denied Apr 1
Denial risk
48%
good odds
Appeal window
closed
nothing left to file
Recovered
$15,685
the money is back

What I did

and what comes next
  1. Claim reached Heron
    Imported from a CSV export
    Apr 1
  2. Denied by UnitedHealthcare
    Bundling/Coding Error (97)
    Apr 1
  3. Heron scored it: 48% denial risk
    3 factors found, appeal path chosen
    Apr 1
  4. Heron
    Paid in full
    The money is back
    May 30

The denial

Bundling/Coding Error, code 97

Patient
Sunita Bhatt, born 1966-04-25
Payer
UnitedHealthcare
Procedure
Chemotherapy, Additional Sequential (96417)
Diagnosis
C18.9
Denied on
Apr 1, 2026
Assigned to
Heron

Appeal successful, payment posted

Heron says
UnitedHealthcare 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.

No appeal yet

I can draft one from this claim's history

View the claim form

This claim is settled, so there is nothing left to write.

What I sent

  • Corrected claim

Everything I know about Sunita

across every queue
Everything for this patient
Open exposure
$28,691
Recovered
$16,971
2 denied claims4 prior auths4 underpayments3 backlog claims
AUTH-4004
96413 · Chemotherapy Infusion, 1st Hour
64% odds
Approved
Aug 20
AUTH-4070
96417 · Chemotherapy, Additional Sequential
71% odds
Approved
Aug 20
AUTH-4026
96417 · Chemotherapy, Additional Sequential
92% odds
Denied
Aug 11
CLM-2026-9116
96417 · Bundling/Coding Error
$8,905
Denied
Aug 5
CLM-2026-5165
96417 · 25d outstanding
$3,534
In follow up
Aug 5
CLM-2026-7092
93000 · underpaid 29.7%
$471 short
Detected
Aug 3
CLM-2026-5002
96413 · 28d outstanding
$4,961
Not submitted
Aug 2
AUTH-4083
96413 · Chemotherapy Infusion, 1st Hour
76% odds
Approved
Jul 28
CLM-2026-7021
93306 · underpaid 8%
$31 short
Under review
Jul 5
CLM-2026-5067
96413 · 114d outstanding
$8,329
In follow up
May 8
CLM-2026-7036
96417 · underpaid 31.3%
$2,460 short
Disputed
Apr 12
CLM-2026-9017viewing
96417 · Bundling/Coding Error
$15,685
Recovered
Apr 1
CLM-2025-7071
96415 · underpaid 12.4%
$1,286 short
Recovered
Sep 30