Claim CLM-2025-9069

Patient

Name: Uma Krishnan
Date of birth: 1977-08-21
Patient id: P003

Payer

Name: BCBS
Payer id code: 00210

Provider

Name: Northside Medical
NPI: 1982744321

Service

Date of service: Dec 10 (denial date, no service date on file)
Procedure: 72148, MRI Lumbar Spine w/o Contrast
Diagnosis code: M51.16
Billed amount: $3,349

Denial

Reason: Medical Necessity, code 50
Date: Dec 10

Appeal

Status: No appeal filed yet

Prepared by Heron on Aug 30.