Nia Okafor

CLM-2026-9039, Aetna, Therapeutic Activities, 15 min (97530)

DeniedWith me Denied claims

Billed

$1,729

denied Aug 10

Denial risk

65%

winnable with the right notes

Appeal window

70d

closes Nov 8

Appeals

none filed yet

What I did

and what comes next

Claim reached Heron
Posted from the 835 remittance
Aug 10
Denied by Aetna
Medical Necessity (50)
Aug 10
Heron scored it: 65% denial risk
3 factors found, appeal path chosen
Aug 10
Appeal window closes
70 days left to file
Nov 8

The denial

Medical Necessity, code 50

Patient: Nia Okafor, born 1994-02-22
Payer: Aetna
Procedure: Therapeutic Activities, 15 min (97530)
Diagnosis: M62.81
Denied on: Aug 10, 2026
Assigned to: Heron

Heron says

Aetna denies 42% of 97530 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.