Keiko Mori

CLM-2026-9035, Medicaid, Chemotherapy, Additional Sequential (96417)

In appealWith the payer Denied claims

Billed

$11,136

denied Apr 27

Denial risk

66%

winnable with the right notes

Appeal window

lapsed

closes Jul 26

Appeals

none filed yet

What I did

and what comes next

Claim reached Heron
Posted from the 835 remittance
Apr 27
Denied by Medicaid
Medical Necessity (50)
Apr 27
Heron scored it: 66% denial risk
3 factors found, appeal path chosen
Apr 27

The denial

Medical Necessity, code 50

Patient: Keiko Mori, born 1972-11-26
Payer: Medicaid
Procedure: Chemotherapy, Additional Sequential (96417)
Diagnosis: C18.9
Denied on: Apr 27, 2026
Assigned to: Heron

Heron says

Medicaid denies 49% of 96417 claims without documented conservative treatment. Clinical notes supporting medical necessity were not attached to the original submission. Attach treatment history and imaging before appealing, overturn rate rises sharply with documentation.