Heron

Fatima Zahra

CLM-2025-9025, BCBS, Chemotherapy, Additional Sequential (96417)

In appealWith the payer Denied claims
Billed
$8,486
denied Nov 11
Denial risk
49%
good odds
Appeal window
lapsed
closes Feb 9
Appeals
0
none filed yet

What I did

and what comes next
  1. Claim reached Heron
    Posted from the 835 remittance
    Nov 11
  2. Denied by BCBS
    Missing Information (16)
    Nov 11
  3. Heron
    Heron scored it: 49% denial risk
    3 factors found, appeal path chosen
    Nov 11

The denial

Missing Information, code 16

Patient
Fatima Zahra, born 1972-05-30
Payer
BCBS
Procedure
Chemotherapy, Additional Sequential (96417)
Diagnosis
C18.9
Denied on
Nov 11, 2026
Assigned to
Heron
Heron says
Claim rejected for incomplete data, most often a missing referring provider NPI or member ID mismatch. Member ID on file (INS320984) should be revalidated against the payer's eligibility response. Corrected claims for this reason typically pay within 26 days.

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What I sent

  • Referral on file

Everything I know about Fatima

across every queue
Everything for this patient
Open exposure
$32,297
Recovered
$0
3 denied claims1 prior auth1 underpayment4 backlog claims
CLM-2026-5062
73630 · 3d outstanding
$1,396
Pending payer
Aug 27
CLM-2026-5125
93000 · 4d outstanding
$465
Not submitted
Aug 26
CLM-2026-9122
96413 · Medical Necessity
$12,366
In appeal
Aug 3
CLM-2026-5001
93306 · 36d outstanding
$439
Awaiting info
Jul 25
AUTH-4033
96417 · Chemotherapy, Additional Sequential
84% odds
Approved
Jul 13
CLM-2026-5082
72110 · 51d outstanding
$839
In follow up
Jul 10
CLM-2026-7053
72110 · underpaid 30.6%
$296 short
Under review
May 25
CLM-2025-9131
96417 · Not Covered
$8,010
In appeal
Dec 13
CLM-2025-9025viewing
96417 · Missing Information
$8,486
In appeal
Nov 11