Claim CLM-2026146004
$5,528.76
billed
$4,955.29
allowed
$0.00
paid
$0.00
patient responsibility
Adjudication lines
| Service | Code | Billed | Paid |
|---|---|---|---|
| Prenatal visit (regime/therapy) | 424619006 | $0.00 | $0.00 |
| Evaluation of uterine fundal height (procedure) | 274804006 | $2,261.69 | $0.00 |
| Auscultation of the fetal heart (procedure) | 225158009 | $2,261.69 | $0.00 |
| Detection of chromosomal aneuploidy in prenatal amniotic fluid specimen using fluorescence in situ hybridization screening technique (procedure) | 443529005 | $862.80 | $0.00 |
Denial risk — 11/99
Scored by the denial-risk model before adjudication. Advisory only — nothing blocks on a score; the factors below cite the adjudication history they came from.
| Factor | Weight |
|---|---|
| High-dollar claim ($5,528.76 billed) — history shows elevated review rates | +0.35 |
| Humana denial history: 331 of 4047 claims denied (8%) | -0.12 |
| Service 274804006 (Evaluation of uterine fundal height (pro): 11 of 177 historically denied (6%) | -0.05 |