CLM-2026-008017
Meadow Clinical Laboratories, Clinical Laboratory. Service 2026-08-10 at independent laboratory (POS 81). Received 2026-08-31.
Member
Resolved through the identity graph
- Member
- Pamela Bradley
- Member ID
- UHC-15237-29
- Date of birth
- 1994-12-07
- Identity
- Verified3 records, confidence 0.97
- Claim record
- CLMCLM-400689
- Relationship
- Spouse, Jacksonville, FL
Coverage and accumulators
Found by member ID
- Plan
- OPTIONS-PPO PPO group GRP-3035
- Coverage period
- 2021-12-01 to present
- Deductible
- $653.50 of $1,000.0065%
- Out-of-pocket maximum
- $1,689.52 of $4,000.0042%
- Copays
- office $40.00, specialist $60.00, emergency $150.00
- Physical therapy visits
- 22 of 20 used
Provider
Billing and rendering
- Billing provider
- Meadow Clinical LaboratoriesClinical Laboratory · taxonomy 291U00000X
- NPI
- 5775545838
- Network
- In network
- Rendering NPI
- 5775545838
- Location
- Miami, FL · TIN 91-7135882
- Authorisation / referral
- none / none
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 | 83036 | Hemoglobin A1c | — | 1 | 1 | $38.00 | $23.56 | $23.56 | $0.00 | Paid |
| 2 | 85025 | Complete blood count with differential | — | 1 | 1 | $52.00 | $32.24 | $32.24 | $0.00 | Paid |
| Totals | $90.00 | $55.80 | $55.80 | $0.00 | ||||||
- 1. E11.9 Type 2 diabetes mellitus without complicationsprincipal
- 2. N39.0 Urinary tract infection, site not specified
- Patient account
- PA-459949
- Frequency code
- 1 (original)
- Accident
- No
- DRG
- —
- Admit / discharge
- —
- Landed
- 2026-10-22 12:44
Rules engine
CLAIMS-ADJ v1: 11 checks, 0 needing attention
| Check | Result | Code | Detail |
|---|---|---|---|
| Member identity | Pass | Attached to MBR-003952 (verified, link confidence 0.97). | |
| Eligibility | Pass | Active on 2026-08-10: OPTIONS-PPO (PPO), effective 2021-12-01. | |
| Timely filing | Pass | Received 21 days after service (limit 90). | |
| Duplicate check | Pass | No matching prior claim in the duplicate window. | |
| Prior authorisation | Pass | No line requires precertification. | |
| Provider network | Pass | In-network provider Meadow Clinical Laboratories (5775545838). | |
| 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 Clinical Laboratories2026-08-10 09:33
Patient seen for type 2 diabetes mellitus without complications.
Attachments
Documents received with the claim
Explanation of benefits
What the member will see
Claim history
Every event on this claim, sealed in the audit chain
- Rules engineApproved2026-10-22 12:44Clean claim.
Other claims for this member
Same resolved identity
AI recommendation
assist mode · apac.amazon.nova-pro-v1:0
Examiner decision
Approved by Claims rules engine; an examiner may still override
Evaluation truth
Hidden label from the synthetic generator; never shown to the model
Clean claim, priced at contract rate.