Heron

Maya Feldman

CLM-2026-9046, Humana, Chemotherapy Infusion, 1st Hour (96413)

Written offWith me Denied claims
Billed
$5,179
denied Apr 1
Denial risk
55%
winnable with the right notes
Appeal window
closed
nothing left to file
Appeals
0
none filed yet

What I did

and what comes next
  1. Claim reached Heron
    Posted from the 835 remittance
    Apr 1
  2. Denied by Humana
    Bundling/Coding Error (97)
    Apr 1
  3. Heron scored it: 55% denial risk
    3 factors found, appeal path chosen
    Apr 1
  4. Heron
    Written off
    Every route exhausted
    Jul 28

The denial

Bundling/Coding Error, code 97

Patient
Maya Feldman, born 1971-12-11
Payer
Humana
Procedure
Chemotherapy Infusion, 1st Hour (96413)
Diagnosis
C50.911
Denied on
Apr 1, 2026
Assigned to
Heron
Heron says
Humana bundled this line into a primary procedure billed the same day. Modifier review recommended, most bundling denials resolve on corrected resubmission. Verify NCCI edit pairs before resubmitting to avoid a second rejection.

No appeal yet

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View the claim form

This claim is settled, so there is nothing left to write.

What I sent

  • Corrected claim

Everything I know about Maya

across every queue
Everything for this patient
Open exposure
$26,549
Recovered
$13,490
2 denied claims3 prior auths2 underpayments5 backlog claims
CLM-2026-5075
96413 · 3d outstanding
$5,323
Pending payer
Aug 27
AUTH-4042
96415 · Chemotherapy Infusion, Addl Hour
84% odds
Pending
Aug 26
CLM-2026-5064
93306 · 7d outstanding
$868
Awaiting info
Aug 23
AUTH-4089
96415 · Chemotherapy Infusion, Addl Hour
45% odds
Approved
Aug 22
CLM-2026-5037
96415 · 11d outstanding
$12,178
In follow up
Aug 19
AUTH-4062
96413 · Chemotherapy Infusion, 1st Hour
84% odds
Approved
Aug 11
CLM-2026-7056
93015 · underpaid 23.4%
$158 short
Under review
Aug 1
CLM-2026-5143
96413 · 47d outstanding
$3,599
In follow up
Jul 14
CLM-2026-5115
93306 · 98d outstanding
$2,329
Awaiting info
May 24
CLM-2026-9164
96417 · Pre-Auth Missing
$13,490
Recovered
May 4
CLM-2026-7045
96415 · underpaid 23.8%
$2,094 short
Disputed
Apr 30
CLM-2026-9046viewing
96413 · Bundling/Coding Error
$5,179
Written off
Apr 1