Claim CLM-2026-9088
Patient
- Name
- Ravi Menon
- Date of birth
- 1987-01-14
- Patient id
- P031
Payer
- Name
- Aetna
- Payer id code
- 60054
Provider
- Name
- Northside Medical
- NPI
- 1982744321
Service
- Date of service
- May 2 (denial date, no service date on file)
- Procedure
- 73721, MRI Lower Extremity Joint
- Diagnosis code
- M23.61
- Billed amount
- $6,271
Denial
- Reason
- Missing Information, code 16
- Date
- May 2
Appeal
- Status
- No appeal filed yet
Prepared by Heron on Aug 30.