CLM-2026-008868
Meadow Medical Group, Internal Medicine. Service 2026-08-16 to 2026-08-18 at inpatient hospital (POS 21). Received 2026-09-26.
Member
Resolved through the identity graph
- Member
- Brandon Alvarado
- Member ID
- UHC-74312-02
- Date of birth
- 1992-07-16
- Identity
- Verified2 records, confidence 0.99
- Claim record
- CLMCLM-400441
- Relationship
- Self, Scottsdale, AZ
Coverage and accumulators
Found by member ID
- Plan
- NULL PPO group UNKNOWN
- Coverage period
- 2021-02-01 to 2026-08-04
- Deductible
- $754.36 of $1,000.0075%
- Out-of-pocket maximum
- $35.19 of $3,000.001%
- Copays
- office $30.00, specialist $60.00, emergency $150.00
- Physical therapy visits
- 10 of 20 used
Provider
Billing and rendering
- Billing provider
- Meadow Medical GroupInternal Medicine · taxonomy 207R00000X
- NPI
- 3950077545
- Network
- In network
- Rendering NPI
- 2421748932
- Location
- Denver, CO · TIN 15-9022901
- Authorisation / referral
- none / none
Service lines
UB-04: procedures, modifiers, units, charges and the pricing outcome per line
| Line | Code | Description | Mod. | Units | Dx | Billed | Allowed | Member | Plan | Line status |
|---|---|---|---|---|---|---|---|---|---|---|
| 1 | 99232 rev 0110 | Subsequent hospital care | — | 1 | 1 | $241.00 | $132.55 | — | — | DeniedCO27 |
| Totals | $241.00 | $132.55 | — | — | ||||||
- 1. I48.91 Unspecified atrial fibrillationprincipal
- Patient account
- PA-254521
- Frequency code
- 1 (original)
- Accident
- No
- DRG
- —
- Admit / discharge
- 2026-08-16 to 2026-08-17
- Landed
- 2026-10-22 12:44
Rules engine
CLAIMS-ADJ v1: 11 checks, 1 needing attention
| Check | Result | Code | Detail |
|---|---|---|---|
| Member identity | Pass | Attached to MBR-005085 (verified, link confidence 0.99). | |
| Eligibility | Fail | CO27 | Date of service 2026-08-16 is after coverage terminated on 2026-08-04. Expenses incurred after coverage terminated |
| Timely filing | Pass | Received 39 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 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 Group2026-08-18 14:12
Follow-up for unspecified atrial fibrillation. Plan discussed, medications reconciled.
- SystemSystem: Claims system2026-09-26 03:29
Attachments
Documents received with the claim
- Itemized billitemized_PA-254521.pdf2 pages
Itemised statement totalling $241.00 across 1 line.
Claim history
Every event on this claim, sealed in the audit chain
- Rules engineDenied2026-10-22 12:44Eligibility: Date of service 2026-08-16 is after coverage terminated on 2026-08-04.
Other claims for this member
Same resolved identity
AI recommendation
assist mode · apac.amazon.nova-pro-v1:0
Examiner decision
Denied by Claims rules engine; an examiner may still override
Evaluation truth
Hidden label from the synthetic generator; never shown to the model
Service after coverage termination.