Beatriz Almeida

CLM-2026-9080, BCBS, Therapeutic Exercise, 15 min (97110)

In appealWith the payer Denied claims

Billed

$225

denied Apr 13

Denial risk

80%

a hard one, worth it

Appeal window

lapsed

closes Jul 12

Appeals

none filed yet

What I did

and what comes next

Claim reached Heron
Imported from a CSV export
Apr 13
Denied by BCBS
Pre-Auth Missing (197)
Apr 13
Heron scored it: 80% denial risk
3 factors found, appeal path chosen
Apr 13

The denial

Pre-Auth Missing, code 197

Patient: Beatriz Almeida, born 1984-10-12
Payer: BCBS
Procedure: Therapeutic Exercise, 15 min (97110)
Diagnosis: M25.561
Denied on: Apr 13, 2026
Assigned to: Heron

Heron says

High recovery risk (80), prioritize this claim in the appeal queue. Prior authorization was not on file at time of service, BCBS auto-denies 97110 without it. 4 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 it View 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 Beatriz

across every queue

Everything for this patient

Open exposure

$8,851

Recovered

$1,083

5 denied claims2 prior auths2 underpayments3 backlog claims

AUTH-4081

96413 · Chemotherapy Infusion, 1st Hour

73630 · 3d outstanding

96415 · Chemotherapy Infusion, Addl Hour

97110 · 14d outstanding

97530 · Missing Information

71046 · 66d outstanding

96415 · Pre-Auth Missing

96413 · underpaid 30.2%

73630 · Medical Necessity

97110 · Pre-Auth Missing

72110 · underpaid 15.7%

97110 · Bundling/Coding Error

$665

Recovered

Feb 9