Claim CLM-2026-9068
Patient
- Name
- Simone Laurent
- Date of birth
- 1966-12-04
- Patient id
- P011
Payer
- Name
- UnitedHealthcare
- Payer id code
- 87726
Provider
- Name
- Northside Medical
- NPI
- 1982744321
Service
- Date of service
- Feb 2 (denial date, no service date on file)
- Procedure
- 96417, Chemotherapy, Additional Sequential
- Diagnosis code
- C18.9
- Billed amount
- $13,808
Denial
- Reason
- Medical Necessity, code 50
- Date
- Feb 2
Appeal
- Status
- No appeal filed yet
Prepared by Heron on Aug 30.