CLM-2026-028912
Meadow Cardiovascular Associates, Cardiology. Service 2026-05-17 at outpatient hospital (POS 22). Received 2026-06-13.
Member
Resolved through the identity graph
- Member
- Amy Lawrence
- Member ID
- UHC-73297-66
- Date of birth
- 2003-09-23
- Identity
- Verified7 records, confidence 0.96
- Claim record
- CLMCLM-415303
- Relationship
- Spouse, Denver, CO
Coverage and accumulators
Found by member ID
- Plan
- CORE-HMO HMO group GRP-6488
- Coverage period
- 2022-07-01 to 2026-05-16
- Deductible
- $736.52 of $2,500.0029%
- Out-of-pocket maximum
- $881.01 of $7,500.0012%
- Copays
- office $20.00, specialist $50.00, emergency $350.00
- Physical therapy visits
- 12 of 20 used
Provider
Billing and rendering
- Billing provider
- Meadow Cardiovascular AssociatesCardiology · taxonomy 207RC0000X
- NPI
- 8180484478
- Network
- In network
- Rendering NPI
- 6561668156
- Location
- Scottsdale, AZ · TIN 33-6309233
- Authorisation / referral
- none / REF607842
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 | 93015 | Cardiovascular stress test | — | 1 | 1 | $464.00 | $255.20 | — | — | DeniedCO27 |
| 2 | 93306 rev 0480 | Echocardiogram, complete | — | 1 | 1 | $1,363.00 | $749.65 | — | — | DeniedCO27 |
| Totals | $1,827.00 | $1,004.85 | — | — | ||||||
- 1. R07.9 Chest pain, unspecifiedprincipal
- Patient account
- PA-186901
- 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-004287 (verified, link confidence 0.96). | |
| Eligibility | Fail | CO27 | Date of service 2026-05-17 is after coverage terminated on 2026-05-16. Expenses incurred after coverage terminated |
| Timely filing | Pass | Received 27 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 Cardiovascular Associates (8180484478). | |
| 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 Cardiovascular Associates2026-05-17 12:16
Patient seen for chest pain, unspecified.
- SystemSystem: Claims system2026-06-13 03:13
Attachments
Documents received with the claim
- Itemized billitemized_PA-186901.pdf3 pages
Itemised statement totalling $1827.00 across 2 lines.
Claim history
Every event on this claim, sealed in the audit chain
- Rules engineDenied2026-10-21 13:43Eligibility: Date of service 2026-05-17 is after coverage terminated on 2026-05-16.
Other claims for this member
Same resolved identity
| Claim | Service | Provider | Billed | Status |
|---|---|---|---|---|
| CLM-2026-003534 | 2026-07-17 | Riverside Clinical Laboratories | $81.00 | Denied |
| CLM-2026-023157 | 2026-01-11 | Canyon Primary Care Associates | $279.00 | Approved |
| CLM-2026-005002 | 2025-12-18 | Valley Community Hospital | $181.00 | Needs review |
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.