Nia Okafor

CLM-2025-9085, Aetna, Therapeutic Activities, 15 min (97530)

Written offWith me Denied claims

Billed

$1,274

denied Dec 13

Denial risk

40%

good odds

Appeal window

closed

nothing left to file

Appeals

none filed yet

What I did

and what comes next

Claim reached Heron
Posted from the 835 remittance
Dec 13
Denied by Aetna
Bundling/Coding Error (97)
Dec 13
Heron scored it: 40% denial risk
3 factors found, appeal path chosen
Dec 13
Written off
Every route exhausted
Apr 6

The denial

Bundling/Coding Error, code 97

Patient: Nia Okafor, born 1994-02-22
Payer: Aetna
Procedure: Therapeutic Activities, 15 min (97530)
Diagnosis: M62.81
Denied on: Dec 13, 2026
Assigned to: Heron

Heron says

Aetna bundled this line into a primary procedure billed the same day. Modifier review recommended, most bundling denials resolve on corrected resubmission. Verify NCCI edit pairs before resubmitting to avoid a second rejection.

No appeal yet

I can draft one from this claim's history

View the claim form

This claim is settled, so there is nothing left to write.

What I sent

Corrected claim

Everything I know about Nia

across every queue

Everything for this patient

Open exposure

$11,019

Recovered

$10,386

6 denied claims2 prior auths2 underpayments3 backlog claims

CLM-2026-5097

96417 · 4d outstanding

96415 · Chemotherapy Infusion, Addl Hour

73630 · 17d outstanding

97530 · Medical Necessity

93000 · underpaid 15.7%

96413 · Chemotherapy Infusion, 1st Hour

97110 · Pre-Auth Missing

93306 · 135d outstanding

96415 · underpaid 7.7%

72110 · Timely Filing

96415 · Pre-Auth Missing

97530 · Bundling/Coding Error

96413 · Medical Necessity

$9,718

Recovered

Nov 19