Heron

Desmond Achebe

CLM-2026-9095, UnitedHealthcare, Echocardiography, Complete (93306)

In appealWith the payer Denied claims
Billed
$1,545
denied May 31
Denial risk
75%
a hard one, worth it
Appeal window
lapsed
closes Aug 29
Appeals
0
none filed yet

What I did

and what comes next
  1. Claim reached Heron
    Entered by hand
    May 31
  2. Denied by UnitedHealthcare
    Pre-Auth Missing (197)
    May 31
  3. Heron
    Heron scored it: 75% denial risk
    3 factors found, appeal path chosen
    May 31

The denial

Pre-Auth Missing, code 197

Patient
Desmond Achebe, born 1993-04-13
Payer
UnitedHealthcare
Procedure
Echocardiography, Complete (93306)
Diagnosis
I50.9
Denied on
May 31, 2026
Assigned to
Heron
Heron says
High recovery risk (75), prioritize this claim in the appeal queue. Prior authorization was not on file at time of service, UnitedHealthcare auto-denies 93306 without it. 4 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 itView 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 Desmond

across every queue
Everything for this patient
Open exposure
$42,344
Recovered
$3,858
4 denied claims3 prior auths3 underpayments6 backlog claims
AUTH-4045
70553 · MRI Brain w/ and w/o Contrast
49% odds
Pending
Aug 23
CLM-2026-5107
70553 · 9d outstanding
$4,153
In follow up
Aug 21
AUTH-4043
96415 · Chemotherapy Infusion, Addl Hour
50% odds
Denied
Aug 14
CLM-2026-5028
93306 · 22d outstanding
$897
Pending payer
Aug 8
AUTH-4073
96417 · Chemotherapy, Additional Sequential
90% odds
Approved
Jul 23
CLM-2026-5038
96415 · 47d outstanding
$12,078
Pending payer
Jul 14
CLM-2026-9095viewing
93306 · Pre-Auth Missing
$1,545
In appeal
May 31
CLM-2026-7024
70553 · underpaid 29.1%
$767 short
Under review
May 7
CLM-2026-7012
97140 · underpaid 8.7%
$84 short
Recovered
Apr 29
CLM-2026-5045
97530 · 132d outstanding
$310
Partially paid
Apr 20
CLM-2026-5057
96417 · 135d outstanding
$6,313
Pending payer
Apr 17
CLM-2026-5117
96417 · 135d outstanding
$16,281
Not submitted
Apr 17
CLM-2026-7033
97530 · underpaid 30.2%
$190 short
Recovered
Mar 22
CLM-2026-9114
70553 · Missing Information
$2,470
Recovered
Mar 2
CLM-2026-9097
97530 · Missing Information
$1,114
Recovered
Feb 28
CLM-2025-9074
97140 · Medical Necessity
$825
Written off
Nov 11