Marcus Oyelaran

CLM-2025-9019, BCBS, Therapeutic Exercise, 15 min (97110)

Written offWith me Denied claims

Billed

$1,657

denied Nov 21

Denial risk

80%

a hard one, worth it

Appeal window

closed

nothing left to file

Appeals

none filed yet

What I did

and what comes next

Claim reached Heron
Posted from the 835 remittance
Nov 21
Denied by BCBS
Coverage Terminated (27)
Nov 21
Heron scored it: 80% denial risk
3 factors found, appeal path chosen
Nov 21
Written off
Every route exhausted
Feb 25

The denial

Coverage Terminated, code 27

Patient: Marcus Oyelaran, born 2000-07-22
Payer: BCBS
Procedure: Therapeutic Exercise, 15 min (97110)
Diagnosis: M25.561
Denied on: Nov 21, 2026
Assigned to: Heron

Heron says

High recovery risk (80), prioritize this claim in the appeal queue. Coverage had terminated as of the date of service per BCBS eligibility. Re-run eligibility for the service date and check for a successor plan.

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

Nothing sent yet.

Everything I know about Marcus

across every queue

Everything for this patient

Open exposure

$26,790

Recovered

$3,391

2 denied claims4 prior auths3 underpayments3 backlog claims

AUTH-4065

96413 · Chemotherapy Infusion, 1st Hour

96415 · Chemotherapy Infusion, Addl Hour

96413 · 3d outstanding

93306 · 3d outstanding

96415 · 9d outstanding

72148 · MRI Lumbar Spine w/o Contrast

73721 · MRI Lower Extremity Joint

97530 · Timely Filing

73721 · underpaid 28%

93306 · underpaid 24.7%

97110 · Coverage Terminated

72148 · underpaid 33.5%

$1,093 short

Recovered

Nov 14