Claim CLM-2026-9051

Patient

Name: Rosa Delgado
Date of birth: 1966-08-14
Patient id: P025

Payer

Name: Cigna
Payer id code: 62308

Provider

Name: Northside Medical
NPI: 1982744321

Service

Date of service: Aug 24 (denial date, no service date on file)
Procedure: 97110, Therapeutic Exercise, 15 min
Diagnosis code: M25.561
Billed amount: $1,115

Denial

Reason: Pre-Auth Missing, code 197
Date: Aug 24

Appeal

Status: No appeal filed yet

Prepared by Heron on Aug 30.