Claim CLM-2026-9058
Patient
- Name
- Grace Mbeki
- Date of birth
- 1980-03-25
- Patient id
- P043
Payer
- Name
- Aetna
- Payer id code
- 60054
Provider
- Name
- Northside Medical
- NPI
- 1982744321
Service
- Date of service
- Aug 4 (denial date, no service date on file)
- Procedure
- 71046, Chest X-Ray, 2 Views
- Diagnosis code
- R05.9
- Billed amount
- $596
Denial
- Reason
- Pre-Auth Missing, code 197
- Date
- Aug 4
Appeal
- Status
- No appeal filed yet
Prepared by Heron on Aug 30.