Aiko Tanaka

CLM-2026-9005, UnitedHealthcare, X-Ray Lumbar Spine, 4+ Views (72110)

In appealWith the payer Denied claims

Billed

$1,449

denied Jul 4

Denial risk

49%

good odds

Appeal window

33d

closes Oct 2

Appeals

none filed yet

What I did

and what comes next

Claim reached Heron
Imported from a CSV export
Jul 4
Denied by UnitedHealthcare
Bundling/Coding Error (97)
Jul 4
Heron scored it: 49% denial risk
3 factors found, appeal path chosen
Jul 4

The denial

Bundling/Coding Error, code 97

Patient: Aiko Tanaka, born 1993-04-13
Payer: UnitedHealthcare
Procedure: X-Ray Lumbar Spine, 4+ Views (72110)
Diagnosis: M54.51
Denied on: Jul 4, 2026
Assigned to: Heron

Heron says

UnitedHealthcare bundled this line into a primary procedure billed the same day. Modifier review recommended, most bundling denials resolve on corrected resubmission. Verify NCCI edit pairs before resubmitting to avoid a second rejection.

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What I sent

Corrected claim

Everything I know about Aiko

across every queue

Everything for this patient

Open exposure

$9,273

Recovered

$370

2 denied claims2 prior auths2 underpayments4 backlog claims

AUTH-4063

70553 · MRI Brain w/ and w/o Contrast

70553 · 3d outstanding

72148 · MRI Lumbar Spine w/o Contrast

71046 · 4d outstanding

73721 · 27d outstanding

71046 · underpaid 30%

72110 · Bundling/Coding Error

72148 · underpaid 24.2%

71046 · 168d outstanding

$329

Partially paid

Mar 15