Mateo Fuentes

CLM-2026-9093, Cigna, MRI Brain w/ and w/o Contrast (70553)

DeniedWith me Denied claims

Billed

$2,542

denied Aug 10

Denial risk

79%

a hard one, worth it

Appeal window

70d

closes Nov 8

Appeals

none filed yet

What I did

and what comes next

Claim reached Heron
Posted from the 835 remittance
Aug 10
Denied by Cigna
Pre-Auth Missing (197)
Aug 10
Heron scored it: 79% denial risk
3 factors found, appeal path chosen
Aug 10
Appeal window closes
70 days left to file
Nov 8

The denial

Pre-Auth Missing, code 197

Patient: Mateo Fuentes, born 1999-02-05
Payer: Cigna
Procedure: MRI Brain w/ and w/o Contrast (70553)
Diagnosis: G43.909
Denied on: Aug 10, 2026
Assigned to: Heron

Heron says

High recovery risk (79), prioritize this claim in the appeal queue. Prior authorization was not on file at time of service, Cigna auto-denies 70553 without it. 2 similar denials at this facility in the last 90 days for the same reason.

No appeal yet

I can draft one from this claim's history

Draft it View 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

Referral on file

Everything I know about Mateo

across every queue

Everything for this patient

Open exposure

$17,601

Recovered

$310

4 denied claims3 prior auths4 underpayments4 backlog claims

AUTH-4019

70553 · MRI Brain w/ and w/o Contrast

72148 · MRI Lumbar Spine w/o Contrast

72148 · 9d outstanding

70553 · MRI Brain w/ and w/o Contrast

70553 · Pre-Auth Missing

73721 · 20d outstanding

70553 · Duplicate Claim

93306 · Medical Necessity

70553 · 38d outstanding

72148 · 64d outstanding

73630 · underpaid 22.6%

72148 · underpaid 12.8%

71046 · underpaid 31.2%

73630 · underpaid 10.7%

$70 short

Recovered

Nov 24