Claim CLM-2026-9033

Patient

Name: Jonah Weiss
Date of birth: 2005-05-15
Patient id: P029

Payer

Name: Cigna
Payer id code: 62308

Provider

Name: Northside Medical
NPI: 1982744321

Service

Date of service: Aug 4 (denial date, no service date on file)
Procedure: 97140, Manual Therapy, 15 min
Diagnosis code: M54.2
Billed amount: $661

Denial

Reason: Pre-Auth Missing, code 197
Date: Aug 4

Appeal

Status: No appeal filed yet

Prepared by Heron on Aug 30.