Heron

Oscar Lindqvist

CLM-2026-9079, Aetna, X-Ray Foot, Complete (73630)

In reviewWith you Denied claims
Billed
$1,285
denied May 4
Denial risk
86%
a hard one, worth it
Appeal window
lapsed
closes Aug 2
Appeals
0
none filed yet

What I did

and what comes next
  1. Claim reached Heron
    Posted from the 835 remittance
    May 4
  2. Denied by Aetna
    Pre-Auth Missing (197)
    May 4
  3. Heron
    Heron scored it: 86% denial risk
    3 factors found, appeal path chosen
    May 4
  4. Appeal window lapsed
    28 days ago
    Aug 2

The denial

Pre-Auth Missing, code 197

Patient
Oscar Lindqvist, born 1995-12-13
Payer
Aetna
Procedure
X-Ray Foot, Complete (73630)
Diagnosis
M79.671
Denied on
May 4, 2026
Assigned to
Heron
Heron says
High recovery risk (86), prioritize this claim in the appeal queue. Prior authorization was not on file at time of service, Aetna auto-denies 73630 without it. 6 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 Oscar

across every queue
Everything for this patient
Open exposure
$18,482
Recovered
$0
3 denied claims1 prior auth0 underpayments4 backlog claims
CLM-2026-5105
93306 · 4d outstanding
$1,549
Pending payer
Aug 26
AUTH-4012
72148 · MRI Lumbar Spine w/o Contrast
46% odds
Pending
Aug 24
CLM-2026-5008
72148 · 15d outstanding
$3,452
Pending payer
Aug 15
CLM-2026-5059
73630 · 23d outstanding
$2,547
Awaiting info
Aug 7
CLM-2026-5094
93000 · 46d outstanding
$2,928
Awaiting info
Jul 15
CLM-2026-9105
93000 · Timely Filing
$5,083
Denied
Jul 2
CLM-2026-9079viewing
73630 · Pre-Auth Missing
$1,285
In review
May 4
CLM-2026-9166
93015 · Missing Information
$1,638
In appeal
May 1