CLM-2026-024385
Meadow Internal Medicine Associates, Internal Medicine. Service 2026-03-26 at office (POS 11). Received 2026-03-29.
Member
Resolved through the identity graph
- Member
- Kenneth Perkins
- Member ID
- UHC-46973-89
- Date of birth
- 1996-07-07
- Identity
- Verified5 records, confidence 1.00
- Claim record
- CLMCLM-402681
- Relationship
- Self, Glendale, AZ
Coverage and accumulators
Found by member ID
- Plan
- CHOICE-PLUS-PPO PPO group GRP-6119
- Coverage period
- 2021-01-01 to present
- Deductible
- $487.42 of $1,000.0049%
- Out-of-pocket maximum
- $349.49 of $2,000.0017%
- Copays
- office $20.00, specialist $75.00, emergency $150.00
- Physical therapy visits
- 20 of 20 used
Provider
Billing and rendering
- Billing provider
- Meadow Internal Medicine AssociatesInternal Medicine · taxonomy 207R00000X
- NPI
- 1151313396
- Network
- In network
- Rendering NPI
- 3029550779
- Location
- Phoenix, AZ · TIN 41-0387297
- 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 | 99214 | Office visit, established patient, moderate complexity | 59 | 1 | 1 | $204.00 | $126.48 | — | — | Review |
| 2 | 93000 | Electrocardiogram with interpretation | 59 | 1 | 2 | $100.00 | $62.00 | — | — | Review |
| Totals | $304.00 | $188.48 | — | — | ||||||
- 1. N18.30 Chronic kidney disease, stage 3 unspecifiedprincipal
- Patient account
- PA-952531
- 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-003454 (verified, link confidence 1.00). | |
| Eligibility | Pass | Active on 2026-03-26: NULL (PPO), effective 2021-01-01. | |
| Timely filing | Pass | Received 3 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 Internal Medicine Associates (1151313396). | |
| Medical necessity | Pass | Diagnosis supports the procedures billed. | |
| Bundling (NCCI) | Review | CO97 | Modifier 59 used on a normally bundled code pair; the operative note must document a distinct procedural service. Benefit included in another service already adjudicated |
| 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 Internal Medicine Associates2026-03-26 10:55
Follow-up for chronic kidney disease, stage 3 unspecified. Plan discussed, medications reconciled. Separate procedure performed at a distinct anatomical site during the same encounter; see operative note for site detail.
- SystemSystem: Claims system2026-03-29 00:49
NCCI edit: modifier 59 used on a code pair that is normally bundled. Operative note requested.
Attachments
Documents received with the claim
- Medical recordrecords_PA-952531.pdf19 pages
Operative note describing procedures at two distinct anatomical sites.
Claim history
Every event on this claim, sealed in the audit chain
- Rules engineReview2026-10-21 13:43Bundling (NCCI): Modifier 59 used on a normally bundled code pair; the operative note must document a distinct procedural service.
Other claims for this member
Same resolved identity
AI recommendation
assist mode · apac.amazon.nova-pro-v1:0
Examiner decision
Record the final decision; pricing and remittance reasons follow from it
Evaluation truth
Hidden label from the synthetic generator; never shown to the model
Modifier 59 supported: distinct anatomical site documented.