Heron

Ingrid Solberg

CLM-2026-9082, UnitedHealthcare, Electrocardiogram, Complete (93000)

In appealWith the payer Denied claims
Billed
$4,094
denied Aug 4
Denial risk
76%
a hard one, worth it
Appeal window
64d
closes Nov 2
Appeals
0
none filed yet

What I did

and what comes next
  1. Claim reached Heron
    Posted from the 835 remittance
    Aug 4
  2. Denied by UnitedHealthcare
    Medical Necessity (50)
    Aug 4
  3. Heron
    Heron scored it: 76% denial risk
    3 factors found, appeal path chosen
    Aug 4

The denial

Medical Necessity, code 50

Patient
Ingrid Solberg, born 1970-02-06
Payer
UnitedHealthcare
Procedure
Electrocardiogram, Complete (93000)
Diagnosis
R00.2
Denied on
Aug 4, 2026
Assigned to
Heron
Heron says
High recovery risk (76), prioritize this claim in the appeal queue. UnitedHealthcare denies 44% of 93000 claims without documented conservative treatment. Clinical notes supporting medical necessity were not attached to the original submission.

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 Ingrid

across every queue
Everything for this patient
Open exposure
$12,916
Recovered
$277
3 denied claims0 prior auths2 underpayments3 backlog claims
CLM-2026-5013
73630 · 3d outstanding
$2,343
Not submitted
Aug 27
CLM-2026-5019
93306 · 16d outstanding
$1,206
In follow up
Aug 14
CLM-2026-9082viewing
93000 · Medical Necessity
$4,094
In appeal
Aug 4
CLM-2026-5022
93000 · 26d outstanding
$565
Partially paid
Aug 4
CLM-2026-9094
93015 · Medical Necessity
$1,054
In review
Jul 7
CLM-2026-9023
93015 · Bundling/Coding Error
$3,432
In review
Jul 4
CLM-2026-7094
93306 · underpaid 24.4%
$222 short
Under review
Mar 6
CLM-2025-7051
93015 · underpaid 13.1%
$277 short
Recovered
Nov 9