Rosa Delgado

CLM-2026-9051, Cigna, Therapeutic Exercise, 15 min (97110)

DeniedWith me Denied claims

Billed

$1,115

denied Aug 24

Denial risk

77%

a hard one, worth it

Appeal window

84d

closes Nov 22

Appeals

none filed yet

What I did

and what comes next

Claim reached Heron
Entered by hand
Aug 24
Denied by Cigna
Pre-Auth Missing (197)
Aug 24
Heron scored it: 77% denial risk
3 factors found, appeal path chosen
Aug 24
Appeal window closes
84 days left to file
Nov 22

The denial

Pre-Auth Missing, code 197

Patient: Rosa Delgado, born 1966-08-14
Payer: Cigna
Procedure: Therapeutic Exercise, 15 min (97110)
Diagnosis: M25.561
Denied on: Aug 24, 2026
Assigned to: Heron

Heron says

High recovery risk (77), prioritize this claim in the appeal queue. Prior authorization was not on file at time of service, Cigna auto-denies 97110 without it. 6 similar denials at this facility in the last 90 days for the same reason.

No appeal yet

I can draft one from this claim's history

Draft it View the claim form

Open Intelligence, pick this claim, and I write the letter from the denial, the payer's rules and the clinical guideline. You sign it here.

What I sent

Referral on file

Everything I know about Rosa

across every queue

Everything for this patient

Open exposure

$13,039

Recovered

$7,606

3 denied claims2 prior auths4 underpayments4 backlog claims

CLM-2026-9051viewing

97110 · Pre-Auth Missing

73721 · underpaid 33.4%

72148 · MRI Lumbar Spine w/o Contrast

93015 · 21d outstanding

70553 · MRI Brain w/ and w/o Contrast

93306 · 94d outstanding

93015 · underpaid 14.3%

70553 · 113d outstanding

93306 · 121d outstanding

72148 · Pre-Auth Missing

97140 · Medical Necessity

73721 · underpaid 26.2%

72148 · underpaid 12.6%

$417 short

Recovered

Nov 15