Claim CLM-2026-9024
Patient
- Name
- Mateo Fuentes
- Date of birth
- 1999-02-05
- Patient id
- P037
Payer
- Name
- Cigna
- Payer id code
- 62308
Provider
- Name
- Northside Medical
- NPI
- 1982744321
Service
- Date of service
- Jul 29 (denial date, no service date on file)
- Procedure
- 93306, Echocardiography, Complete
- Diagnosis code
- I50.9
- Billed amount
- $462
Denial
- Reason
- Medical Necessity, code 50
- Date
- Jul 29
Appeal
- Status
- No appeal filed yet
Prepared by Heron on Aug 30.