Patient Information
Patricia Lee
DOB: Sep 12, 1948 · Female
(555) 678-9012
p.lee@email.com
Naples, FL 34102
Insurance
Medicare Part B
Member ID: 1PL2-AB3-QR45
Group: N/A
Effective: Sep 1, 2013
Medical Codes
A5500Diabetic shoe, custom molded
Qty: 1
$620.00
A5512Multi-density insert, custom
Qty: 3
$270.00
Attachments (1)
diabetic_shoe_rx.pdf
Activity Timeline
Encounter recorded
Dec 1, 2025 · System
Pre-auth submitted
Dec 2, 2025 · System
Claim submitted
Dec 4, 2025 · System
Claim denied – missing certification
Dec 20, 2025 · Medicare
Claimly Denial Prediction
Get prior authorization before submitting
These codes may not be covered — confirm with the payer before submitting
Claimly Suggestions
Obtain podiatrist certification before resubmitting
File first-level appeal with supporting documentation
Billing Summary
Risk Assessment
Medicare requires additional documentation for diabetic shoe coverage
Missing podiatrist certification form