Heron

Tomas Herrera

CLM-2025-9047, UnitedHealthcare, MRI Lumbar Spine w/o Contrast (72148)

RecoveredWith me Denied claims
Billed
$5,604
denied Dec 29
Denial risk
49%
good odds
Appeal window
closed
nothing left to file
Recovered
$5,604
the money is back

What I did

and what comes next
  1. Claim reached Heron
    Posted from the 835 remittance
    Dec 29
  2. Denied by UnitedHealthcare
    Bundling/Coding Error (97)
    Dec 29
  3. Heron scored it: 49% denial risk
    3 factors found, appeal path chosen
    Dec 29
  4. Heron
    Paid in full
    The money is back
    Mar 20

The denial

Bundling/Coding Error, code 97

Patient
Tomas Herrera, born 1968-02-27
Payer
UnitedHealthcare
Procedure
MRI Lumbar Spine w/o Contrast (72148)
Diagnosis
M51.16
Denied on
Dec 29, 2026
Assigned to
Heron

Appeal successful, payment posted

Heron says
UnitedHealthcare 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

I can draft one from this claim's history

View the claim form

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

What I sent

  • Corrected claim

Everything I know about Tomas

across every queue
Everything for this patient
Open exposure
$40,108
Recovered
$24,365
6 denied claims2 prior auths0 underpayments5 backlog claims
CLM-2026-5123
93000 · 3d outstanding
$2,373
Partially paid
Aug 27
CLM-2026-5145
70553 · 3d outstanding
$5,298
Pending payer
Aug 27
CLM-2026-5087
93000 · 4d outstanding
$2,360
In follow up
Aug 26
CLM-2026-9147
93306 · Missing Information
$4,292
Denied
Aug 22
CLM-2026-5128
73721 · 35d outstanding
$4,800
Pending payer
Jul 26
AUTH-4064
72148 · MRI Lumbar Spine w/o Contrast
45% odds
Expired
Jul 24
CLM-2026-5164
72148 · 37d outstanding
$3,828
Pending payer
Jul 24
AUTH-4011
96417 · Chemotherapy, Additional Sequential
41% odds
Denied
Jul 18
CLM-2026-9148
96417 · Coverage Terminated
$13,977
Denied
Jun 25
CLM-2026-9054
93000 · Bundling/Coding Error
$3,180
In appeal
Apr 19
CLM-2025-9047viewing
72148 · Bundling/Coding Error
$5,604
Recovered
Dec 29
CLM-2025-9004
96417 · Medical Necessity
$12,770
Recovered
Dec 4
CLM-2025-9083
70553 · Bundling/Coding Error
$5,991
Recovered
Nov 25