Claim CLM-2025-9092
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
- Nov 22 (denial date, no service date on file)
- Procedure
- 96413, Chemotherapy Infusion, 1st Hour
- Diagnosis code
- C50.911
- Billed amount
- $10,662
Denial
- Reason
- Missing Information, code 16
- Date
- Nov 22
Appeal
- Status
- No appeal filed yet
Prepared by Heron on Aug 30.