Claim CLM-2026-9044
Patient
- Name
- Paloma Reyes
- Date of birth
- 1990-03-28
- Patient id
- P013
Payer
- Name
- Aetna
- Payer id code
- 60054
Provider
- Name
- Northside Medical
- NPI
- 1982744321
Service
- Date of service
- Jun 21 (denial date, no service date on file)
- Procedure
- 96415, Chemotherapy Infusion, Addl Hour
- Diagnosis code
- C34.90
- Billed amount
- $3,108
Denial
- Reason
- Missing Information, code 16
- Date
- Jun 21
Appeal
- Status
- No appeal filed yet
Prepared by Heron on Aug 30.