Claim CLM-2026-9070
Patient
- Name
- Teodora Petrova
- Date of birth
- 1983-03-24
- Patient id
- P048
Payer
- Name
- BCBS
- Payer id code
- 00210
Provider
- Name
- Northside Medical
- NPI
- 1982744321
Service
- Date of service
- Jul 19 (denial date, no service date on file)
- Procedure
- 93000, Electrocardiogram, Complete
- Diagnosis code
- R00.2
- Billed amount
- $3,290
Denial
- Reason
- Pre-Auth Missing, code 197
- Date
- Jul 19
Appeal
- Status
- No appeal filed yet
Prepared by Heron on Aug 30.