Heron

Ingrid Solberg

CLM-2026-9053, UnitedHealthcare, Therapeutic Activities, 15 min (97530)

In appealWith the payer Denied claims
Billed
$1,714
denied Jun 22
Denial risk
75%
a hard one, worth it
Appeal window
21d
closes Sep 20
Appeals
0
none filed yet

What I did

and what comes next
  1. Claim reached Heron
    Imported from a CSV export
    Jun 22
  2. Denied by UnitedHealthcare
    Medical Necessity (50)
    Jun 22
  3. Heron
    Heron scored it: 75% denial risk
    3 factors found, appeal path chosen
    Jun 22

The denial

Medical Necessity, code 50

Patient
Ingrid Solberg, born 1997-12-26
Payer
UnitedHealthcare
Procedure
Therapeutic Activities, 15 min (97530)
Diagnosis
M62.81
Denied on
Jun 22, 2026
Assigned to
Heron
Heron says
High recovery risk (75), prioritize this claim in the appeal queue. UnitedHealthcare denies 58% of 97530 claims without documented conservative treatment. Clinical notes supporting medical necessity were not attached to the original submission.

No appeal yet

I can draft one from this claim's history

Draft itView 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

  • Clinical notes
  • Operative report

Everything I know about Ingrid

across every queue
Everything for this patient
Open exposure
$47,744
Recovered
$1,962
5 denied claims5 prior auths4 underpayments4 backlog claims
AUTH-4021
96417 · Chemotherapy, Additional Sequential
58% odds
Pending
Aug 28
CLM-2026-5074
93015 · 3d outstanding
$2,447
In follow up
Aug 27
AUTH-4017
72148 · MRI Lumbar Spine w/o Contrast
69% odds
Pending
Aug 26
CLM-2026-5014
96417 · 7d outstanding
$16,789
Pending payer
Aug 23
AUTH-4040
70553 · MRI Brain w/ and w/o Contrast
81% odds
Approved
Aug 5
AUTH-4059
70553 · MRI Brain w/ and w/o Contrast
83% odds
Denied
Aug 1
AUTH-4047
96413 · Chemotherapy Infusion, 1st Hour
73% odds
Approved
Jul 21
CLM-2026-9009
72148 · Medical Necessity
$1,768
In appeal
Jul 8
CLM-2026-9034
93000 · Medical Necessity
$2,169
Denied
Jul 8
CLM-2026-9053viewing
97530 · Medical Necessity
$1,714
In appeal
Jun 22
CLM-2026-9096
96413 · Timely Filing
$12,842
In appeal
Jun 13
CLM-2026-9168
93000 · Pre-Auth Missing
$2,494
In appeal
May 25
CLM-2026-5050
70553 · 99d outstanding
$4,631
Not submitted
May 23
CLM-2026-7081
73721 · underpaid 28.5%
$174 short
Under review
Apr 30
CLM-2026-5040
96413 · 145d outstanding
$2,716
Not submitted
Apr 7
CLM-2026-7063
96417 · underpaid 14.7%
$803 short
Recovered
Feb 26
CLM-2026-7022
70553 · underpaid 23.7%
$448 short
Recovered
Jan 4
CLM-2025-7065
96417 · underpaid 8.7%
$711 short
Recovered
Nov 22