CLM-2026-003332
Meadow Medical Group, Internal Medicine. Service 2026-08-26 at office (POS 11). Received 2026-09-18.
Member
Resolved through the identity graph
- Member
- Katherine Palmer
- Member ID
- UHC-33792-42
- Date of birth
- 1982-02-11
- Identity
- Verified2 records, confidence 0.99
- Claim record
- CLMCLM-427579
- Relationship
- Self, Plano, TX
Coverage and accumulators
Found by member ID
- Plan
- NAVIGATE-HMO HMO group GRP-2288
- Coverage period
- 2024-03-01 to present
- Deductible
- $2,691.59 of $3,500.0077%
- Out-of-pocket maximum
- $236.54 of $10,500.002%
- Copays
- office $40.00, specialist $40.00, emergency $350.00
- Physical therapy visits
- 20 of 20 used
Provider
Billing and rendering
- Billing provider
- Meadow Medical GroupInternal Medicine · taxonomy 207R00000X
- NPI
- 3950077545
- Network
- In network
- Rendering NPI
- 6555730178
- Location
- Denver, CO · TIN 15-9022901
- Authorisation / referral
- none / REF960404
Service lines
CMS-1500: procedures, modifiers, units, charges and the pricing outcome per line
| Line | Code | Description | Mod. | Units | Dx | Billed | Allowed | Member | Plan | Line status |
|---|---|---|---|---|---|---|---|---|---|---|
| 1 | 99215 | Office visit, established patient, high complexity | — | 1 | 1 | $384.00 | $238.08 | — | — | Review |
| Totals | $384.00 | $238.08 | — | — | ||||||
- 1. E11.65 Type 2 diabetes mellitus with hyperglycemiaprincipal
- Patient account
- PA-634255
- Frequency code
- 7 (replacement)
- Accident
- No
- DRG
- —
- Admit / discharge
- —
- Landed
- 2026-10-21 13:43
Rules engine
CLAIMS-ADJ v1: 12 checks, 1 needing attention
| Check | Result | Code | Detail |
|---|---|---|---|
| Member identity | Pass | Attached to MBR-023352 (verified, link confidence 0.99). | |
| Eligibility | Pass | Active on 2026-08-26: NAVIGATE-HMO (HMO), effective 2024-03-01. | |
| Timely filing | Pass | Received 23 days after service (limit 90). | |
| Duplicate check | Pass | No matching prior claim in the duplicate window. | |
| Replacement claim | Review | REPL | Frequency code 7 replaces CLM-2026-003331; the original must be voided when this adjudicates. Replacement claim; supersedes the original submission |
| Prior authorisation | Pass | No line requires precertification. | |
| Provider network | Pass | In-network provider Meadow Medical Group (3950077545). | |
| Medical necessity | Pass | Diagnosis supports the procedures billed. | |
| Bundling (NCCI) | Pass | No bundling conflicts. | |
| Benefit limits | Pass | No limited benefit on this claim. | |
| Completeness | Pass | Required documentation present. | |
| High-dollar review | Pass | Within the auto-adjudication ceiling. |
Notes
Provider, system and examiner notes on this claim
- ClinicalProvider: Meadow Medical Group2026-08-26 11:58
Follow-up for type 2 diabetes mellitus with hyperglycemia. Plan discussed, medications reconciled. Corrected claim: units on line 2 were keyed incorrectly on the original submission. This claim replaces it in full.
- SystemSystem: Claims system2026-09-18 01:03
Frequency code 7 (replacement) referencing an earlier claim. Original must be voided when this adjudicates.
Attachments
Documents received with the claim
- Corrected claimcorrected_CLM-2026-003331.pdf1 page
Provider cover letter requesting replacement of CLM-2026-003331.
Claim history
Every event on this claim, sealed in the audit chain
- Rules engineReview2026-10-21 13:43Replacement claim: Frequency code 7 replaces CLM-2026-003331; the original must be voided when this adjudicates.
Other claims for this member
Same resolved identity
| Claim | Service | Provider | Billed | Status |
|---|---|---|---|---|
| CLM-2026-003331 | 2026-08-26 | Meadow Medical Group | $384.00 | Approved |
AI recommendation
assist mode · apac.amazon.nova-pro-v1:0
Examiner decision
Record the final decision; pricing and remittance reasons follow from it
Evaluation truth
Hidden label from the synthetic generator; never shown to the model
Replacement claim supersedes the original.