Claim CLM-2026-9076
Patient
- Name
- Isabel Carvalho
- Date of birth
- 1989-06-08
- Patient id
- P007
Payer
- Name
- UnitedHealthcare
- Payer id code
- 87726
Provider
- Name
- Northside Medical
- NPI
- 1982744321
Service
- Date of service
- Aug 7 (denial date, no service date on file)
- Procedure
- 71046, Chest X-Ray, 2 Views
- Diagnosis code
- R05.9
- Billed amount
- $1,413
Denial
- Reason
- Medical Necessity, code 50
- Date
- Aug 7
Appeal
- Status
- No appeal filed yet
Prepared by Heron on Aug 30.