Hannah Kowalczyk

CLM-2025-9003, Medicare, MRI Brain w/ and w/o Contrast (70553)

In appealWith the payer Denied claims

Billed

$5,035

denied Dec 30

Denial risk

91%

a hard one, worth it

Appeal window

lapsed

closes Mar 30

Appeals

none filed yet

What I did

and what comes next

Claim reached Heron
Entered by hand
Dec 30
Denied by Medicare
Pre-Auth Missing (197)
Dec 30
Heron scored it: 91% denial risk
3 factors found, appeal path chosen
Dec 30

The denial

Pre-Auth Missing, code 197

Patient: Hannah Kowalczyk, born 1955-05-10
Payer: Medicare
Procedure: MRI Brain w/ and w/o Contrast (70553)
Diagnosis: G43.909
Denied on: Dec 30, 2026
Assigned to: Heron

Heron says

High recovery risk (91), prioritize this claim in the appeal queue. Prior authorization was not on file at time of service, Medicare auto-denies 70553 without it. 3 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 Hannah

across every queue

Everything for this patient

Open exposure

$17,932

Recovered

$16,371

8 denied claims2 prior auths0 underpayments3 backlog claims

AUTH-4057

73721 · MRI Lower Extremity Joint

70553 · MRI Brain w/ and w/o Contrast

93000 · Timely Filing

73721 · 74d outstanding

93306 · 134d outstanding

73721 · Medical Necessity

93000 · 181d outstanding

73721 · Missing Information

93306 · Medical Necessity

70553 · Pre-Auth Missing

73721 · Medical Necessity

72148 · Timely Filing

$2,698

Recovered

Dec 14