Teodora Petrova

CLM-2026-9070, BCBS, Electrocardiogram, Complete (93000)

In appealWith the payer Denied claims

Billed

$3,290

denied Jul 19

Denial risk

80%

a hard one, worth it

Appeal window

48d

closes Oct 17

Appeals

none filed yet

What I did

and what comes next

Claim reached Heron
Entered by hand
Jul 19
Denied by BCBS
Pre-Auth Missing (197)
Jul 19
Heron scored it: 80% denial risk
3 factors found, appeal path chosen
Jul 19

The denial

Pre-Auth Missing, code 197

Patient: Teodora Petrova, born 1983-03-24
Payer: BCBS
Procedure: Electrocardiogram, Complete (93000)
Diagnosis: R00.2
Denied on: Jul 19, 2026
Assigned to: Heron

Heron says

High recovery risk (80), prioritize this claim in the appeal queue. Prior authorization was not on file at time of service, BCBS auto-denies 93000 without it. 6 similar denials at this facility in the last 90 days for the same reason.

No appeal yet

I can draft one from this claim's history

Draft it View the claim form

Open Intelligence, pick this claim, and I write the letter from the denial, the payer's rules and the clinical guideline. You sign it here.

What I sent

Referral on file

Everything I know about Teodora

across every queue

Everything for this patient

Open exposure

$8,706

Recovered

$1,615

4 denied claims2 prior auths3 underpayments1 backlog claim

AUTH-4046

72148 · MRI Lumbar Spine w/o Contrast

72148 · 3d outstanding

72148 · MRI Lumbar Spine w/o Contrast

97530 · Missing Information

93000 · Pre-Auth Missing

97110 · underpaid 32.1%

72148 · underpaid 21.9%

93306 · Medical Necessity

97140 · Medical Necessity

93000 · underpaid 18.3%

$330 short

Recovered

Nov 15