Claim CLM-2026-9096
Patient
- Name
- Ingrid Solberg
- Date of birth
- 1997-12-26
- Patient id
- P036
Payer
- Name
- UnitedHealthcare
- Payer id code
- 87726
Provider
- Name
- Northside Medical
- NPI
- 1982744321
Service
- Date of service
- Jun 13 (denial date, no service date on file)
- Procedure
- 96413, Chemotherapy Infusion, 1st Hour
- Diagnosis code
- C50.911
- Billed amount
- $12,842
Denial
- Reason
- Timely Filing, code 29
- Date
- Jun 13
Appeal
- Status
- No appeal filed yet
Prepared by Heron on Aug 30.