Beatriz Almeida

CLM-2026-9020, BCBS, Therapeutic Exercise, 15 min (97110)

RecoveredWith me Denied claims

Billed

$665

denied Feb 9

Denial risk

36%

good odds

Appeal window

closed

nothing left to file

Recovered

$665

the money is back

What I did

and what comes next

Claim reached Heron
Posted from the 835 remittance
Feb 9
Denied by BCBS
Bundling/Coding Error (97)
Feb 9
Heron scored it: 36% denial risk
3 factors found, appeal path chosen
Feb 9
Paid in full
The money is back
Jun 6

The denial

Bundling/Coding Error, code 97

Patient: Beatriz Almeida, born 1984-10-12
Payer: BCBS
Procedure: Therapeutic Exercise, 15 min (97110)
Diagnosis: M25.561
Denied on: Feb 9, 2026
Assigned to: Heron

Appeal successful, payment posted

Heron says

BCBS bundled this line into a primary procedure billed the same day. Modifier review recommended, most bundling denials resolve on corrected resubmission. Verify NCCI edit pairs before resubmitting to avoid a second rejection.

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

Corrected claim

Everything I know about Beatriz

across every queue

Everything for this patient

Open exposure

$8,851

Recovered

$1,083

5 denied claims2 prior auths2 underpayments3 backlog claims

AUTH-4081

96413 · Chemotherapy Infusion, 1st Hour

73630 · 3d outstanding

96415 · Chemotherapy Infusion, Addl Hour

97110 · 14d outstanding

97530 · Missing Information

71046 · 66d outstanding

96415 · Pre-Auth Missing

96413 · underpaid 30.2%

73630 · Medical Necessity

97110 · Pre-Auth Missing

72110 · underpaid 15.7%

97110 · Bundling/Coding Error

$665

Recovered

Feb 9