Claim CLM-2026-9091
Patient
- Name
- Owen Gallagher
- Date of birth
- 1950-01-26
- Patient id
- P034
Payer
- Name
- Medicare
- Payer id code
- 00882
Provider
- Name
- Northside Medical
- NPI
- 1982744321
Service
- Date of service
- Apr 19 (denial date, no service date on file)
- Procedure
- 71046, Chest X-Ray, 2 Views
- Diagnosis code
- R05.9
- Billed amount
- $1,348
Denial
- Reason
- Not Covered, code 96
- Date
- Apr 19
Appeal
- Status
- No appeal filed yet
Prepared by Heron on Aug 30.