CLM-2026-011984
Meadow Clinical Laboratories, Clinical Laboratory. Service 2026-05-17 at independent laboratory (POS 81). Received 2026-06-01.
Member
Resolved through the identity graph
- Member
- Ralph Daniels
- Member ID
- UHC-44422-88
- Date of birth
- 2001-07-07
- Identity
- Verified5 records, confidence 0.99
- Claim record
- CLMCLM-407085
- Relationship
- Self, Phoenix, AZ
Coverage and accumulators
Found by member ID
- Plan
- CORE-HMO HMO group GRP-9160
- Coverage period
- 2023-10-01 to present
- Deductible
- $315.07 of $1,500.0021%
- Out-of-pocket maximum
- $794.73 of $6,000.0013%
- Copays
- office $30.00, specialist $50.00, emergency $150.00
- Physical therapy visits
- 1 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 / REF527461
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 | $80.00 | $49.60 | $49.60 | $0.00 | Paid |
| 2 | 85025 | Complete blood count with differential | 25 | 1 | 1,2 | $53.00 | $32.86 | $32.86 | $0.00 | Paid |
| Totals | $133.00 | $82.46 | $82.46 | $0.00 | ||||||
- 1. E11.9 Type 2 diabetes mellitus without complicationsprincipal
- 2. E78.5 Hyperlipidemia, unspecified
- Patient account
- PA-872908
- Frequency code
- 1 (original)
- Accident
- No
- DRG
- —
- Admit / discharge
- —
- Landed
- 2026-10-21 13:43
Rules engine
CLAIMS-ADJ v1: 11 checks, 0 needing attention
| Check | Result | Code | Detail |
|---|---|---|---|
| Member identity | Pass | Attached to MBR-000036 (verified, link confidence 0.99). | |
| Eligibility | Pass | Active on 2026-05-17: CORE-HMO (HMO), effective 2023-10-01. | |
| Timely filing | Pass | Received 15 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 (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 Laboratories2026-05-17 16:20
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 engineApproved2026-10-21 13:43Clean claim.
Other claims for this member
Same resolved identity
| Claim | Service | Provider | Billed | Status |
|---|---|---|---|---|
| CLM-2026-025639 | 2026-05-06 | Summit Clinical Laboratories | $47.00 | Approved |
| CLM-2026-005163 | 2025-11-30 | Canyon Community Hospital | $2,258.00 | Denied |
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.