CLM-2026-029459
Meadow Cardiovascular Associates, Cardiology. Service 2026-09-07 at outpatient hospital (POS 22). Received 2026-10-03.
Member
Resolved through the identity graph
- Member
- Christian Rojas
- Member ID
- UHC-82285-28
- Date of birth
- 2002-10-10
- Identity
- Verified4 records, confidence 0.99
- Claim record
- CLMCLM-409460
- Relationship
- Self, Phoenix, AZ
Coverage and accumulators
Found by member ID
- Plan
- NAVIGATE-HMO HMO group GRP-6239
- Coverage period
- 2024-07-01 to present
- Deductible
- $526.82 of $2,500.0021%
- Out-of-pocket maximum
- $3,059.79 of $7,500.0041%
- Copays
- office $25.00, specialist $75.00, emergency $350.00
- Physical therapy visits
- 0 of 20 used
Provider
Billing and rendering
- Billing provider
- Meadow Cardiovascular AssociatesCardiology · taxonomy 207RC0000X
- NPI
- 2145896462
- Network
- In network
- Rendering NPI
- 5554719968
- Location
- Scottsdale, AZ · TIN 58-0592913
- Authorisation / referral
- PA2026025087 / REF640988
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 | $640.00 | $352.00 | $352.00 | $0.00 | Paid |
| 2 | 93458 rev 0481 | Cardiac catheterisation, left heart | — | 1 | 1 | $6,355.00 | $3,495.25 | $1,995.99 | $1,499.26 | Paid |
| Totals | $6,995.00 | $3,847.25 | $2,347.99 | $1,499.26 | ||||||
- 1. I25.10 Atherosclerotic heart disease of native coronary artery without anginaprincipal
- Patient account
- PA-118167
- 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-030487 (verified, link confidence 0.99). | |
| Eligibility | Pass | Active on 2026-09-07: NAVIGATE-HMO (HMO), effective 2024-07-01. | |
| Timely filing | Pass | Received 26 days after service (limit 90). | |
| Duplicate check | Pass | No matching prior claim in the duplicate window. | |
| Prior authorisation | Pass | Authorisation PA2026025087 on file for 93458. | |
| Provider network | Pass | In-network provider Meadow Cardiovascular Associates (2145896462). | |
| 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 Associates2026-09-07 18:01
Patient seen for atherosclerotic heart disease of native coronary artery without angina.
Attachments
Documents received with the claim
- Prior auth letterPA2026025087_approval.pdf2 pages
Utilisation management approval letter for 93015 (Cardiovascular stress test), valid 2026-09-07 to 2026-12-06.
- Itemized billitemized_PA-118167.pdf4 pages
Itemised statement totalling $6995.00 across 2 lines.
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-2026-020129 | 2026-08-08 | Canyon Reference Lab | $160.00 | 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.