Uma Krishnan

CLM-2025-9069, BCBS, MRI Lumbar Spine w/o Contrast (72148)

In appealWith the payer Denied claims

Billed

$3,349

denied Dec 10

Denial risk

68%

winnable with the right notes

Appeal window

lapsed

closes Mar 10

Appeals

none filed yet

What I did

and what comes next

Claim reached Heron
Posted from the 835 remittance
Dec 10
Denied by BCBS
Medical Necessity (50)
Dec 10
Heron scored it: 68% denial risk
3 factors found, appeal path chosen
Dec 10

The denial

Medical Necessity, code 50

Patient: Uma Krishnan, born 1977-08-21
Payer: BCBS
Procedure: MRI Lumbar Spine w/o Contrast (72148)
Diagnosis: M51.16
Denied on: Dec 10, 2026
Assigned to: Heron

Heron says

BCBS denies 50% of 72148 claims without documented conservative treatment. Clinical notes supporting medical necessity were not attached to the original submission. Attach treatment history and imaging before appealing, overturn rate rises sharply with documentation.