Claim CLM-2026-9095
Patient
- Name
- Desmond Achebe
- Date of birth
- 1993-04-13
- Patient id
- P035
Payer
- Name
- UnitedHealthcare
- Payer id code
- 87726
Provider
- Name
- Northside Medical
- NPI
- 1982744321
Service
- Date of service
- May 31 (denial date, no service date on file)
- Procedure
- 93306, Echocardiography, Complete
- Diagnosis code
- I50.9
- Billed amount
- $1,545
Denial
- Reason
- Pre-Auth Missing, code 197
- Date
- May 31
Appeal
- Status
- No appeal filed yet
Prepared by Heron on Aug 30.