Claim CLM-2026-9061
Patient
- Name
- Marcus Oyelaran
- Date of birth
- 1986-09-01
- Patient id
- P046
Payer
- Name
- UnitedHealthcare
- Payer id code
- 87726
Provider
- Name
- Northside Medical
- NPI
- 1982744321
Service
- Date of service
- Mar 15 (denial date, no service date on file)
- Procedure
- 73721, MRI Lower Extremity Joint
- Diagnosis code
- M23.61
- Billed amount
- $4,809
Denial
- Reason
- Not Covered, code 96
- Date
- Mar 15
Appeal
- Status
- No appeal filed yet
Prepared by Heron on Aug 30.