Owen Gallagher

CLM-2026-9091, Medicare, Chest X-Ray, 2 Views (71046)

RecoveredWith me Denied claims

Billed

$1,348

denied Apr 19

Denial risk

55%

winnable with the right notes

Appeal window

closed

nothing left to file

Recovered

$1,348

the money is back

What I did

and what comes next

Claim reached Heron
Entered by hand
Apr 19
Denied by Medicare
Not Covered (96)
Apr 19
Heron scored it: 55% denial risk
3 factors found, appeal path chosen
Apr 19
Paid in full
The money is back
Jul 31

The denial

Not Covered, code 96

Patient: Owen Gallagher, born 1950-01-26
Payer: Medicare
Procedure: Chest X-Ray, 2 Views (71046)
Diagnosis: R05.9
Denied on: Apr 19, 2026
Assigned to: Heron

Appeal successful, payment posted

Heron says

Service is excluded under the member's current Medicare benefit plan. Verify benefits as of the date of service, plan may have changed mid-year. If non-covered is confirmed, route to patient responsibility rather than appeal.

No appeal yet

I can draft one from this claim's history

View the claim form

This claim is settled, so there is nothing left to write.

What I sent

Nothing sent yet.

Everything I know about Owen

across every queue

Everything for this patient

Open exposure

$17,554

Recovered

$3,366

4 denied claims1 prior auth1 underpayment2 backlog claims

AUTH-4000

96413 · Chemotherapy Infusion, 1st Hour

73630 · Medical Necessity

72110 · Bundling/Coding Error

96413 · 53d outstanding

71046 · 98d outstanding

71046 · Medical Necessity