Claim CLM-2026-9040
Patient
- Name
- Noor Rahimi
- Date of birth
- 1991-05-01
- Patient id
- P017
Payer
- Name
- Medicaid
- Payer id code
- 77043
Provider
- Name
- Northside Medical
- NPI
- 1982744321
Service
- Date of service
- Aug 8 (denial date, no service date on file)
- Procedure
- 73721, MRI Lower Extremity Joint
- Diagnosis code
- M23.61
- Billed amount
- $5,856
Denial
- Reason
- Medical Necessity, code 50
- Date
- Aug 8
Appeal
- Status
- No appeal filed yet
Prepared by Heron on Aug 30.