Grace Mbeki

CLM-2026-9058, Aetna, Chest X-Ray, 2 Views (71046)

DeniedWith me Denied claims

Billed

$596

denied Aug 4

Denial risk

86%

a hard one, worth it

Appeal window

64d

closes Nov 2

Appeals

none filed yet

What I did

and what comes next

Claim reached Heron
Posted from the 835 remittance
Aug 4
Denied by Aetna
Pre-Auth Missing (197)
Aug 4
Heron scored it: 86% denial risk
3 factors found, appeal path chosen
Aug 4
Appeal window closes
64 days left to file
Nov 2

The denial

Pre-Auth Missing, code 197

Patient: Grace Mbeki, born 1980-03-25
Payer: Aetna
Procedure: Chest X-Ray, 2 Views (71046)
Diagnosis: R05.9
Denied on: Aug 4, 2026
Assigned to: Heron

Heron says

High recovery risk (86), prioritize this claim in the appeal queue. Prior authorization was not on file at time of service, Aetna auto-denies 71046 without it. 3 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 Grace

across every queue

Everything for this patient

Open exposure

$35,702

Recovered

3 denied claims2 prior auths1 underpayment3 backlog claims

AUTH-4034

96417 · Chemotherapy, Additional Sequential

96415 · 6d outstanding

96417 · Chemotherapy, Additional Sequential

71046 · Pre-Auth Missing

96417 · 32d outstanding

96417 · underpaid 15%

96417 · 54d outstanding

96417 · Missing Information

96417 · Medical Necessity

$2,568

In appeal

Jan 23