Claim CLM-2026-9094
Patient
- Name
- Ingrid Solberg
- Date of birth
- 1970-02-06
- Patient id
- P033
Payer
- Name
- UnitedHealthcare
- Payer id code
- 87726
Provider
- Name
- Northside Medical
- NPI
- 1982744321
Service
- Date of service
- Jul 7 (denial date, no service date on file)
- Procedure
- 93015, Cardiovascular Stress Test
- Diagnosis code
- I25.10
- Billed amount
- $1,054
Denial
- Reason
- Medical Necessity, code 50
- Date
- Jul 7
Appeal
- Status
- No appeal filed yet
Prepared by Heron on Aug 30.