Claim CLM-2026-9057
Patient
- Name
- Nia Okafor
- Date of birth
- 1994-02-22
- Patient id
- P023
Payer
- Name
- Aetna
- Payer id code
- 60054
Provider
- Name
- Northside Medical
- NPI
- 1982744321
Service
- Date of service
- Feb 16 (denial date, no service date on file)
- Procedure
- 72110, X-Ray Lumbar Spine, 4+ Views
- Diagnosis code
- M54.51
- Billed amount
- $447
Denial
- Reason
- Timely Filing, code 29
- Date
- Feb 16
Appeal
- Status
- No appeal filed yet
Prepared by Heron on Aug 30.