Jonah Weiss

CLM-2026-9033, Cigna, Manual Therapy, 15 min (97140)

In reviewWith you Denied claims

Billed

$661

denied Aug 4

Denial risk

90%

a hard one, worth it

Appeal window

64d

closes Nov 2

Appeals

none filed yet

What I did

and what comes next

Claim reached Heron
Posted from the 835 remittance
Aug 4
Denied by Cigna
Pre-Auth Missing (197)
Aug 4
Heron scored it: 90% denial risk
3 factors found, appeal path chosen
Aug 4
Appeal window closes
64 days left to file
Nov 2

The denial

Pre-Auth Missing, code 197

Patient: Jonah Weiss, born 2005-05-15
Payer: Cigna
Procedure: Manual Therapy, 15 min (97140)
Diagnosis: M54.2
Denied on: Aug 4, 2026
Assigned to: Heron

Heron says

High recovery risk (90), prioritize this claim in the appeal queue. Prior authorization was not on file at time of service, Cigna auto-denies 97140 without it. 6 similar denials at this facility in the last 90 days for the same reason.

No appeal yet

I can draft one from this claim's history

Draft it View the claim form

Open Intelligence, pick this claim, and I write the letter from the denial, the payer's rules and the clinical guideline. You sign it here.

What I sent

Referral on file

Everything I know about Jonah

across every queue

Everything for this patient

Open exposure

$55,849

Recovered

$2,485

4 denied claims3 prior auths3 underpayments6 backlog claims

AUTH-4037

96417 · Chemotherapy, Additional Sequential

71046 · 3d outstanding

96417 · 3d outstanding

96417 · 4d outstanding

96415 · Chemotherapy Infusion, Addl Hour

96415 · 15d outstanding

96417 · underpaid 11.1%

97140 · Pre-Auth Missing

96417 · Medical Necessity

96413 · Chemotherapy Infusion, 1st Hour

97110 · 44d outstanding

96417 · Medical Necessity

96413 · 89d outstanding

96413 · underpaid 25.9%

93306 · underpaid 14.1%

$76 short

Written off

Oct 3