Claim CLM-2026-9036
Patient
- Name
- Luis Ortega
- Date of birth
- 1991-11-04
- Patient id
- P024
Payer
- Name
- Aetna
- Payer id code
- 60054
Provider
- Name
- Northside Medical
- NPI
- 1982744321
Service
- Date of service
- Apr 8 (denial date, no service date on file)
- Procedure
- 93306, Echocardiography, Complete
- Diagnosis code
- I50.9
- Billed amount
- $1,099
Denial
- Reason
- Medical Necessity, code 50
- Date
- Apr 8
Appeal
- Status
- No appeal filed yet
Prepared by Heron on Aug 30.