Claim CLM-2025-9019
Patient
- Name
- Marcus Oyelaran
- Date of birth
- 2000-07-22
- Patient id
- P016
Payer
- Name
- BCBS
- Payer id code
- 00210
Provider
- Name
- Northside Medical
- NPI
- 1982744321
Service
- Date of service
- Nov 21 (denial date, no service date on file)
- Procedure
- 97110, Therapeutic Exercise, 15 min
- Diagnosis code
- M25.561
- Billed amount
- $1,657
Denial
- Reason
- Coverage Terminated, code 27
- Date
- Nov 21
Appeal
- Status
- No appeal filed yet
Prepared by Heron on Aug 30.