Claim CLM-2026-9087
Patient
- Name
- Uma Krishnan
- Date of birth
- 1977-08-21
- Patient id
- P003
Payer
- Name
- BCBS
- Payer id code
- 00210
Provider
- Name
- Northside Medical
- NPI
- 1982744321
Service
- Date of service
- Jul 2 (denial date, no service date on file)
- Procedure
- 72148, MRI Lumbar Spine w/o Contrast
- Diagnosis code
- M51.16
- Billed amount
- $3,988
Denial
- Reason
- Timely Filing, code 29
- Date
- Jul 2
Appeal
- Status
- No appeal filed yet
Prepared by Heron on Aug 30.