Beatriz Almeida

CLM-2026-9067, BCBS, Chemotherapy Infusion, Addl Hour (96415)

In reviewWith you Denied claims

Billed

$4,533

denied Jun 20

Denial risk

83%

a hard one, worth it

Appeal window

19d

closes Sep 18

Appeals

none filed yet

What I did

and what comes next

Claim reached Heron
Imported from a CSV export
Jun 20
Denied by BCBS
Pre-Auth Missing (197)
Jun 20
Heron scored it: 83% denial risk
3 factors found, appeal path chosen
Jun 20
Appeal window closes
19 days left to file
Sep 18

The denial

Pre-Auth Missing, code 197

Patient: Beatriz Almeida, born 1984-10-12
Payer: BCBS
Procedure: Chemotherapy Infusion, Addl Hour (96415)
Diagnosis: C34.90
Denied on: Jun 20, 2026
Assigned to: Heron

Heron says

High recovery risk (83), prioritize this claim in the appeal queue. Prior authorization was not on file at time of service, BCBS auto-denies 96415 without it. 6 similar denials at this facility in the last 90 days for the same reason.

No appeal yet

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What I sent

Referral on file

Everything I know about Beatriz

across every queue

Everything for this patient

Open exposure

$8,851

Recovered

$1,083

5 denied claims2 prior auths2 underpayments3 backlog claims

AUTH-4081

96413 · Chemotherapy Infusion, 1st Hour

73630 · 3d outstanding

96415 · Chemotherapy Infusion, Addl Hour

97110 · 14d outstanding

97530 · Missing Information

71046 · 66d outstanding

96415 · Pre-Auth Missing

96413 · underpaid 30.2%

73630 · Medical Necessity

97110 · Pre-Auth Missing

72110 · underpaid 15.7%

97110 · Bundling/Coding Error

$665

Recovered

Feb 9