Claim CLM-2026-9001
Patient
- Name
- Priya Raman
- Date of birth
- 1955-06-04
- Patient id
- P001
Payer
- Name
- Medicare
- Payer id code
- 00882
Provider
- Name
- Northside Medical
- NPI
- 1982744321
Service
- Date of service
- Jul 14 (denial date, no service date on file)
- Procedure
- 96417, Chemotherapy, Additional Sequential
- Diagnosis code
- C18.9
- Billed amount
- $1,826
Denial
- Reason
- Pre-Auth Missing, code 197
- Date
- Jul 14
Appeal
- Status
- No appeal filed yet
Prepared by Heron on Aug 30.