Claim CLM-2026-9017
Patient
- Name
- Sunita Bhatt
- Date of birth
- 1966-04-25
- Patient id
- P045
Payer
- Name
- UnitedHealthcare
- Payer id code
- 87726
Provider
- Name
- Northside Medical
- NPI
- 1982744321
Service
- Date of service
- Apr 1 (denial date, no service date on file)
- Procedure
- 96417, Chemotherapy, Additional Sequential
- Diagnosis code
- C18.9
- Billed amount
- $15,685
Denial
- Reason
- Bundling/Coding Error, code 97
- Date
- Apr 1
Appeal
- Status
- No appeal filed yet
Prepared by Heron on Aug 30.