Heron

Jonah Weiss

CLM-2026-9060, UnitedHealthcare, Therapeutic Activities, 15 min (97530)

In reviewWith you Denied claims
Billed
$1,066
denied Aug 1
Denial risk
89%
a hard one, worth it
Appeal window
61d
closes Oct 30
Appeals
0
none filed yet

What I did

and what comes next
  1. Claim reached Heron
    Imported from a CSV export
    Aug 1
  2. Denied by UnitedHealthcare
    Pre-Auth Missing (197)
    Aug 1
  3. Heron
    Heron scored it: 89% denial risk
    3 factors found, appeal path chosen
    Aug 1
  4. Appeal window closes
    61 days left to file
    Oct 30

The denial

Pre-Auth Missing, code 197

Patient
Jonah Weiss, born 1991-06-25
Payer
UnitedHealthcare
Procedure
Therapeutic Activities, 15 min (97530)
Diagnosis
M62.81
Denied on
Aug 1, 2026
Assigned to
Heron
Heron says
High recovery risk (89), prioritize this claim in the appeal queue. Prior authorization was not on file at time of service, UnitedHealthcare auto-denies 97530 without it. 4 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 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

  • Referral on file

Everything I know about Jonah

across every queue
Everything for this patient
Open exposure
$8,086
Recovered
$2,354
4 denied claims0 prior auths1 underpayment1 backlog claim
CLM-2026-5095
97110 · 13d outstanding
$2,552
Pending payer
Aug 17
CLM-2026-9089
97110 · Timely Filing
$1,663
Denied
Aug 8
CLM-2026-9081
97530 · Medical Necessity
$2,805
In appeal
Aug 4
CLM-2026-9060viewing
97530 · Pre-Auth Missing
$1,066
In review
Aug 1
CLM-2025-9139
97110 · Bundling/Coding Error
$1,840
Recovered
Nov 27
CLM-2025-7060
97530 · underpaid 33.9%
$514 short
Recovered
Sep 28