CLM-2026-009012
Meadow Clinical Laboratories, Clinical Laboratory. Service 2026-06-13 at independent laboratory (POS 81). Received 2026-07-23.
Member
Resolved through the identity graph
- Member
- Keith Gordon
- Member ID
- UHC-14722-66
- Date of birth
- 1965-09-11
- Identity
- Verified4 records, confidence 1.00
- Claim record
- CLMCLM-420252
- Relationship
- Self, Dallas, TX
Coverage and accumulators
Found by member ID
- Plan
- CORE-HMO HMO group GRP-5454
- Coverage period
- 2023-04-01 to present
- Deductible
- $886.77 of $1,500.0059%
- Out-of-pocket maximum
- $1,465.39 of $4,500.0033%
- Copays
- office $30.00, specialist $50.00, emergency $250.00
- Physical therapy visits
- 3 of 20 used
Provider
Billing and rendering
- Billing provider
- Meadow Clinical LaboratoriesClinical Laboratory · taxonomy 291U00000X
- NPI
- 6855554898
- Network
- In network
- Rendering NPI
- 6855554898
- Location
- Scottsdale, AZ · TIN 20-9059141
- Authorisation / referral
- none / REF275861
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 | $42.00 | $26.04 | — | — | DeniedCO18 |
| 2 | 80061 | Lipid panel | 25 | 1 | 1 | $37.00 | $22.94 | — | — | DeniedCO18 |
| 3 | 85025 | Complete blood count with differential | — | 1 | 1,2 | $70.00 | $43.40 | — | — | DeniedCO18 |
| Totals | $149.00 | $92.38 | — | — | ||||||
- 1. E78.5 Hyperlipidemia, unspecifiedprincipal
- 2. E11.9 Type 2 diabetes mellitus without complications
- Patient account
- PA-771883
- Frequency code
- 1 (original)
- Accident
- No
- DRG
- —
- Admit / discharge
- —
- Landed
- 2026-10-21 13:43
Rules engine
CLAIMS-ADJ v1: 11 checks, 1 needing attention
| Check | Result | Code | Detail |
|---|---|---|---|
| Member identity | Pass | Attached to MBR-000748 (verified, link confidence 1.00). | |
| Eligibility | Pass | Active on 2026-06-13: CORE-HMO (HMO), effective 2023-04-01. | |
| Timely filing | Pass | Received 40 days after service (limit 90). | |
| Duplicate check | Fail | CO18 | Exact duplicate of CLM-2026-009011: same member, date of service, procedures and billing provider. Exact duplicate claim or service |
| Prior authorisation | Pass | No line requires precertification. | |
| Provider network | Pass | In-network provider Meadow Clinical Laboratories (6855554898). | |
| 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 Laboratories2026-06-13 14:59
Patient seen for hyperlipidemia, unspecified.
- SystemSystem: Claims system2026-07-23 01:10
System edit 018 fired: identical member, date of service, procedure and billing provider as a prior submission.
Attachments
Documents received with the claim
Claim history
Every event on this claim, sealed in the audit chain
- Rules engineDenied2026-10-21 13:43Duplicate check: Exact duplicate of CLM-2026-009011: same member, date of service, procedures and billing provider.
Other claims for this member
Same resolved identity
| Claim | Service | Provider | Billed | Status |
|---|---|---|---|---|
| CLM-2026-009011 | 2026-06-13 | Meadow Clinical Laboratories | $149.00 | Approved |
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
Exact duplicate of an earlier submission.