Claim CLM-2025-9074
Patient
- Name
- Desmond Achebe
- Date of birth
- 1993-04-13
- Patient id
- P035
Payer
- Name
- UnitedHealthcare
- Payer id code
- 87726
Provider
- Name
- Northside Medical
- NPI
- 1982744321
Service
- Date of service
- Nov 11 (denial date, no service date on file)
- Procedure
- 97140, Manual Therapy, 15 min
- Diagnosis code
- M54.2
- Billed amount
- $825
Denial
- Reason
- Medical Necessity, code 50
- Date
- Nov 11
Appeal
- Status
- No appeal filed yet
Prepared by Heron on Aug 30.