CLM-2026-016661
Meadow Primary Care Associates, Family Medicine. Service 2026-07-27 at office (POS 11). Received 2026-08-28.
Member
Resolved through the identity graph
- Member
- Sharon Welch
- Member ID
- UHC-81282-68
- Date of birth
- 1939-01-15
- Identity
- Verified5 records, confidence 0.97
- Claim record
- CLMCLM-403545
- Relationship
- Spouse, Austin, TX
Coverage and accumulators
Found by member ID
- Plan
- MEDICARE-ADV-A MA group GRP-8033
- Coverage period
- 2021-06-01 to present
- Deductible
- $593.31 of $1,000.0059%
- Out-of-pocket maximum
- $1,372.15 of $3,000.0046%
- Copays
- office $20.00, specialist $60.00, emergency $150.00
- Physical therapy visits
- 2 of 20 used
Provider
Billing and rendering
- Billing provider
- Meadow Primary Care AssociatesFamily Medicine · taxonomy 207Q00000X
- NPI
- 5061732918
- Network
- In network
- Rendering NPI
- 8135714656
- Location
- Scottsdale, AZ · TIN 54-2819857
- 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 | 99395 | Preventive visit, 18-39 years | — | 1 | 1 | $275.00 | $170.50 | $20.00 | $150.50 | Paid |
| 2 | 90471 | Immunization administration | — | 1 | 1 | $44.00 | $27.28 | $0.00 | $27.28 | Paid |
| Totals | $319.00 | $197.78 | $20.00 | $177.78 | ||||||
- 1. E11.9 Type 2 diabetes mellitus without complicationsprincipal
- 2. Z00.00 Encounter for general adult medical examination without abnormal findings
- Patient account
- PA-518768
- 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-019156 (verified, link confidence 0.97). | |
| Eligibility | Pass | Active on 2026-07-27: MEDICARE-ADV-A (MA), effective 2021-06-01. | |
| Timely filing | Pass | Received 32 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 Primary Care Associates (5061732918). | |
| 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 Primary Care Associates2026-07-27 10:32
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
| Claim | Service | Provider | Billed | Status |
|---|---|---|---|---|
| CLM-2026-005886 | 2026-09-13 | Unity Digestive Health Center | $1,525.00 | Approved |
| CLM-2026-025477 | 2026-03-12 | Desert Medical Group | $289.00 | Approved |
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.