Heron

Yusuf Demir

CLM-2026-9078, Cigna, Cardiovascular Stress Test (93015)

DeniedWith me Denied claims
Billed
$2,928
denied Aug 8
Denial risk
84%
a hard one, worth it
Appeal window
68d
closes Nov 6
Appeals
0
none filed yet

What I did

and what comes next
  1. Claim reached Heron
    Posted from the 835 remittance
    Aug 8
  2. Denied by Cigna
    Pre-Auth Missing (197)
    Aug 8
  3. Heron
    Heron scored it: 84% denial risk
    3 factors found, appeal path chosen
    Aug 8
  4. Appeal window closes
    68 days left to file
    Nov 6

The denial

Pre-Auth Missing, code 197

Patient
Yusuf Demir, born 1981-02-20
Payer
Cigna
Procedure
Cardiovascular Stress Test (93015)
Diagnosis
I25.10
Denied on
Aug 8, 2026
Assigned to
Heron
Heron says
High recovery risk (84), prioritize this claim in the appeal queue. Prior authorization was not on file at time of service, Cigna auto-denies 93015 without it. 3 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 itView 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 Yusuf

across every queue
Everything for this patient
Open exposure
$12,010
Recovered
$0
4 denied claims0 prior auths0 underpayments2 backlog claims
CLM-2026-9133
72110 · Medical Necessity
$2,083
In review
Aug 20
CLM-2026-9018
93306 · Medical Necessity
$3,635
Denied
Aug 16
CLM-2026-9107
93306 · Medical Necessity
$2,873
Denied
Aug 14
CLM-2026-9078viewing
93015 · Pre-Auth Missing
$2,928
Denied
Aug 8
CLM-2026-5032
72110 · 36d outstanding
$218
Partially paid
Jul 25
CLM-2026-5126
71046 · 48d outstanding
$273
In follow up
Jul 13