Claim CLM-2025-9025
Patient
- Name
- Fatima Zahra
- Date of birth
- 1972-05-30
- Patient id
- P040
Payer
- Name
- BCBS
- Payer id code
- 00210
Provider
- Name
- Northside Medical
- NPI
- 1982744321
Service
- Date of service
- Nov 11 (denial date, no service date on file)
- Procedure
- 96417, Chemotherapy, Additional Sequential
- Diagnosis code
- C18.9
- Billed amount
- $8,486
Denial
- Reason
- Missing Information, code 16
- Date
- Nov 11
Appeal
- Status
- No appeal filed yet
Prepared by Heron on Aug 30.