Claim CLM-2026-9021
Patient
- Name
- Aiko Tanaka
- Date of birth
- 1981-01-08
- Patient id
- P032
Payer
- Name
- UnitedHealthcare
- Payer id code
- 87726
Provider
- Name
- Northside Medical
- NPI
- 1982744321
Service
- Date of service
- Jun 24 (denial date, no service date on file)
- Procedure
- 97140, Manual Therapy, 15 min
- Diagnosis code
- M54.2
- Billed amount
- $1,545
Denial
- Reason
- Pre-Auth Missing, code 197
- Date
- Jun 24
Appeal
- Status
- No appeal filed yet
Prepared by Heron on Aug 30.