Heron

Jonah Weiss

CLM-2026-9081, UnitedHealthcare, Therapeutic Activities, 15 min (97530)

In appealWith the payer Denied claims
Billed
$2,805
denied Aug 4
Denial risk
71%
winnable with the right notes
Appeal window
64d
closes Nov 2
Appeals
0
none filed yet

What I did

and what comes next
  1. Claim reached Heron
    Entered by hand
    Aug 4
  2. Denied by UnitedHealthcare
    Medical Necessity (50)
    Aug 4
  3. Heron
    Heron scored it: 71% denial risk
    3 factors found, appeal path chosen
    Aug 4

The denial

Medical Necessity, code 50

Patient
Jonah Weiss, born 1991-06-25
Payer
UnitedHealthcare
Procedure
Therapeutic Activities, 15 min (97530)
Diagnosis
M62.81
Denied on
Aug 4, 2026
Assigned to
Heron
Heron says
UnitedHealthcare denies 45% of 97530 claims without documented conservative treatment. Clinical notes supporting medical necessity were not attached to the original submission. Attach treatment history and imaging before appealing, overturn rate rises sharply with documentation.

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

  • Clinical notes
  • Operative report

Everything I know about Jonah

across every queue
Everything for this patient
Open exposure
$8,086
Recovered
$2,354
4 denied claims0 prior auths1 underpayment1 backlog claim
CLM-2026-5095
97110 · 13d outstanding
$2,552
Pending payer
Aug 17
CLM-2026-9089
97110 · Timely Filing
$1,663
Denied
Aug 8
CLM-2026-9081viewing
97530 · Medical Necessity
$2,805
In appeal
Aug 4
CLM-2026-9060
97530 · Pre-Auth Missing
$1,066
In review
Aug 1
CLM-2025-9139
97110 · Bundling/Coding Error
$1,840
Recovered
Nov 27
CLM-2025-7060
97530 · underpaid 33.9%
$514 short
Recovered
Sep 28