Noor Rahimi

CLM-2026-9098, Medicaid, Chemotherapy Infusion, 1st Hour (96413)

In appealWith the payer Denied claims

Billed

$13,334

denied May 30

Denial risk

69%

winnable with the right notes

Appeal window

lapsed

closes Aug 28

Appeals

none filed yet

What I did

and what comes next

Claim reached Heron
Imported from a CSV export
May 30
Denied by Medicaid
Medical Necessity (50)
May 30
Heron scored it: 69% denial risk
3 factors found, appeal path chosen
May 30

The denial

Medical Necessity, code 50

Patient: Noor Rahimi, born 1991-05-01
Payer: Medicaid
Procedure: Chemotherapy Infusion, 1st Hour (96413)
Diagnosis: C50.911
Denied on: May 30, 2026
Assigned to: Heron

Heron says

Medicaid denies 51% of 96413 claims without documented conservative treatment. Clinical notes supporting medical necessity were not attached to the original submission. Attach treatment history and imaging before appealing, overturn rate rises sharply with documentation.