Claim CLM-2026-9086
Patient
- Name
- Viktor Novak
- Date of birth
- 1976-07-05
- Patient id
- P008
Payer
- Name
- Aetna
- Payer id code
- 60054
Provider
- Name
- Northside Medical
- NPI
- 1982744321
Service
- Date of service
- Mar 23 (denial date, no service date on file)
- Procedure
- 97530, Therapeutic Activities, 15 min
- Diagnosis code
- M62.81
- Billed amount
- $962
Denial
- Reason
- Not Covered, code 96
- Date
- Mar 23
Appeal
- Status
- No appeal filed yet
Prepared by Heron on Aug 30.