Priya Raman

CLM-2026-9001, Medicare, Chemotherapy, Additional Sequential (96417)

DeniedWith me Denied claims

Billed

$1,826

denied Jul 14

Denial risk

83%

a hard one, worth it

Appeal window

43d

closes Oct 12

Appeals

none filed yet

What I did

and what comes next

Claim reached Heron
Posted from the 835 remittance
Jul 14
Denied by Medicare
Pre-Auth Missing (197)
Jul 14
Heron scored it: 83% denial risk
3 factors found, appeal path chosen
Jul 14
Appeal window closes
43 days left to file
Oct 12

The denial

Pre-Auth Missing, code 197

Patient: Priya Raman, born 1955-06-04
Payer: Medicare
Procedure: Chemotherapy, Additional Sequential (96417)
Diagnosis: C18.9
Denied on: Jul 14, 2026
Assigned to: Heron

Heron says

High recovery risk (83), prioritize this claim in the appeal queue. Prior authorization was not on file at time of service, Medicare auto-denies 96417 without it. 2 similar denials at this facility in the last 90 days for the same reason.

No appeal yet

I can draft one from this claim's history

Draft it View the claim form

Open Intelligence, pick this claim, and I write the letter from the denial, the payer's rules and the clinical guideline. You sign it here.

What I sent

Referral on file

Everything I know about Priya

across every queue

Everything for this patient

Open exposure

$30,147

Recovered

$2,537

7 denied claims2 prior auths1 underpayment4 backlog claims

AUTH-4024

96417 · Chemotherapy, Additional Sequential

96417 · Chemotherapy, Additional Sequential

97530 · 6d outstanding

96417 · Missing Information

97110 · 8d outstanding

96417 · Bundling/Coding Error

93000 · underpaid 13.9%

96417 · Pre-Auth Missing

97530 · 123d outstanding

96417 · 158d outstanding

96415 · Pre-Auth Missing

96417 · Timely Filing

96415 · Medical Necessity

97110 · Medical Necessity

$1,262

Recovered

Nov 26