Viktor Novak

CLM-2026-9086, Aetna, Therapeutic Activities, 15 min (97530)

RecoveredWith me Denied claims

Billed

$962

denied Mar 23

Denial risk

64%

winnable with the right notes

Appeal window

closed

nothing left to file

Recovered

$962

the money is back

What I did

and what comes next

Claim reached Heron
Posted from the 835 remittance
Mar 23
Denied by Aetna
Not Covered (96)
Mar 23
Heron scored it: 64% denial risk
3 factors found, appeal path chosen
Mar 23
Paid in full
The money is back
Jul 8

The denial

Not Covered, code 96

Patient: Viktor Novak, born 1976-07-05
Payer: Aetna
Procedure: Therapeutic Activities, 15 min (97530)
Diagnosis: M62.81
Denied on: Mar 23, 2026
Assigned to: Heron

Appeal successful, payment posted

Heron says

Service is excluded under the member's current Aetna benefit plan. Verify benefits as of the date of service, plan may have changed mid-year. If non-covered is confirmed, route to patient responsibility rather than appeal.

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

Nothing sent yet.

Everything I know about Viktor

across every queue

Everything for this patient

Open exposure

$2,869

Recovered

$1,077

1 denied claim0 prior auths1 underpayment4 backlog claims

CLM-2026-5089

97110 · 5d outstanding

97530 · 9d outstanding

97110 · 10d outstanding

97530 · 19d outstanding

97140 · underpaid 24.6%