Elliot Marchetti

CLM-2026-9032, Aetna, Chemotherapy, Additional Sequential (96417)

DeniedWith me Denied claims

Billed

$9,711

denied Jun 26

Denial risk

54%

good odds

Appeal window

25d

closes Sep 24

Appeals

none filed yet

What I did

and what comes next

Claim reached Heron
Posted from the 835 remittance
Jun 26
Denied by Aetna
Not Covered (96)
Jun 26
Heron scored it: 54% denial risk
3 factors found, appeal path chosen
Jun 26
Appeal window closes
25 days left to file
Sep 24

The denial

Not Covered, code 96

Patient: Elliot Marchetti, born 1993-12-27
Payer: Aetna
Procedure: Chemotherapy, Additional Sequential (96417)
Diagnosis: C18.9
Denied on: Jun 26, 2026
Assigned to: Heron

Heron says

Service is excluded under the member's current Aetna benefit plan. Verify benefits as of the date of service, plan may have changed mid-year. If non-covered is confirmed, route to patient responsibility rather than appeal.

No appeal yet

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Draft it View the claim form

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What I sent

Nothing sent yet.

Everything I know about Elliot

across every queue

Everything for this patient

Open exposure

$44,591

Recovered

5 denied claims3 prior auths2 underpayments3 backlog claims

AUTH-4080

70553 · MRI Brain w/ and w/o Contrast

96417 · Chemotherapy, Additional Sequential

70553 · MRI Brain w/ and w/o Contrast

73721 · 11d outstanding

70553 · underpaid 33.1%

73721 · Medical Necessity

70553 · Duplicate Claim

93000 · 118d outstanding

93306 · 126d outstanding

96417 · Missing Information

70553 · underpaid 12.2%

72148 · Medical Necessity

$1,743

Written off

Jan 2