Heron

Caleb Nguyen

CLM-2026-9008, Medicare, Therapeutic Activities, 15 min (97530)

In appealWith the payer Denied claims
Billed
$1,276
denied May 28
Denial risk
36%
good odds
Appeal window
lapsed
closes Aug 26
Appeals
0
none filed yet

What I did

and what comes next
  1. Claim reached Heron
    Entered by hand
    May 28
  2. Denied by Medicare
    Duplicate Claim (18)
    May 28
  3. Heron
    Heron scored it: 36% denial risk
    3 factors found, appeal path chosen
    May 28

The denial

Duplicate Claim, code 18

Patient
Caleb Nguyen, born 1950-12-12
Payer
Medicare
Procedure
Therapeutic Activities, 15 min (97530)
Diagnosis
M62.81
Denied on
May 28, 2026
Assigned to
Heron
Heron says
Flagged as a duplicate of a claim submitted for the same date of service. Review service line detail, same-day related procedures often trip duplicate logic. Resubmit with an appropriate distinct-service modifier if the services were separate.

No appeal yet

I can draft one from this claim's history

Draft itView the claim form

Open Intelligence, pick this claim, and I write the letter from the denial, the payer's rules and the clinical guideline. You sign it here.

What I sent

  • Corrected claim

Everything I know about Caleb

across every queue
Everything for this patient
Open exposure
$15,454
Recovered
$2,295
2 denied claims1 prior auth3 underpayments3 backlog claims
CLM-2026-9077
97530 · Pre-Auth Missing
$350
Denied
Aug 23
CLM-2026-5110
96415 · 10d outstanding
$8,737
Partially paid
Aug 20
CLM-2026-5056
71046 · 32d outstanding
$2,347
Not submitted
Jul 29
AUTH-4069
96415 · Chemotherapy Infusion, Addl Hour
84% odds
Denied
Jul 15
CLM-2026-5072
73630 · 55d outstanding
$2,744
In follow up
Jul 6
CLM-2026-9008viewing
97530 · Duplicate Claim
$1,276
In appeal
May 28
CLM-2026-7026
73630 · underpaid 30.5%
$100 short
Recovered
Mar 23
CLM-2025-7062
96413 · underpaid 15.5%
$1,616 short
Recovered
Nov 21
CLM-2025-7035
96415 · underpaid 27%
$579 short
Recovered
Sep 30