Paloma Reyes

CLM-2026-9044, Aetna, Chemotherapy Infusion, Addl Hour (96415)

DeniedWith me Denied claims

Billed

$3,108

denied Jun 21

Denial risk

35%

good odds

Appeal window

20d

closes Sep 19

Appeals

none filed yet

What I did

and what comes next

Claim reached Heron
Posted from the 835 remittance
Jun 21
Denied by Aetna
Missing Information (16)
Jun 21
Heron scored it: 35% denial risk
3 factors found, appeal path chosen
Jun 21
Appeal window closes
20 days left to file
Sep 19

The denial

Missing Information, code 16

Patient: Paloma Reyes, born 1990-03-28
Payer: Aetna
Procedure: Chemotherapy Infusion, Addl Hour (96415)
Diagnosis: C34.90
Denied on: Jun 21, 2026
Assigned to: Heron

Heron says

Claim rejected for incomplete data, most often a missing referring provider NPI or member ID mismatch. Member ID on file (INS373237) should be revalidated against the payer's eligibility response. Corrected claims for this reason typically pay within 27 days.