Keiko Mori

CLM-2026-9041, Medicaid, Chemotherapy Infusion, 1st Hour (96413)

DeniedWith me Denied claims

Billed

$14,703

denied Jun 22

Denial risk

59%

winnable with the right notes

Appeal window

21d

closes Sep 20

Appeals

none filed yet

What I did

and what comes next

Claim reached Heron
Imported from a CSV export
Jun 22
Denied by Medicaid
Medical Necessity (50)
Jun 22
Heron scored it: 59% denial risk
3 factors found, appeal path chosen
Jun 22
Appeal window closes
21 days left to file
Sep 20

The denial

Medical Necessity, code 50

Patient: Keiko Mori, born 1972-11-26
Payer: Medicaid
Procedure: Chemotherapy Infusion, 1st Hour (96413)
Diagnosis: C50.911
Denied on: Jun 22, 2026
Assigned to: Heron

Heron says

Medicaid denies 58% of 96413 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.