Claim CLM-2026-9077
Patient
- Name
- Caleb Nguyen
- Date of birth
- 1950-12-12
- Patient id
- P039
Payer
- Name
- Medicare
- Payer id code
- 00882
Provider
- Name
- Northside Medical
- NPI
- 1982744321
Service
- Date of service
- Aug 23 (denial date, no service date on file)
- Procedure
- 97530, Therapeutic Activities, 15 min
- Diagnosis code
- M62.81
- Billed amount
- $350
Denial
- Reason
- Pre-Auth Missing, code 197
- Date
- Aug 23
Appeal
- Status
- No appeal filed yet
Prepared by Heron on Aug 30.