Claim CLM-2026-9090
Patient
- Name
- Maya Feldman
- Date of birth
- 1991-12-08
- Patient id
- P012
Payer
- Name
- UnitedHealthcare
- Payer id code
- 87726
Provider
- Name
- Northside Medical
- NPI
- 1982744321
Service
- Date of service
- Jan 13 (denial date, no service date on file)
- Procedure
- 96415, Chemotherapy Infusion, Addl Hour
- Diagnosis code
- C34.90
- Billed amount
- $5,278
Denial
- Reason
- Missing Information, code 16
- Date
- Jan 13
Appeal
- Status
- No appeal filed yet
Prepared by Heron on Aug 30.