CLM-2026-029708
Meadow Cardiovascular Associates, Cardiology. Service 2026-08-19 at outpatient hospital (POS 22). Received 2026-09-21.
Member
Resolved through the identity graph
- Member
- James Maldonado
- Member ID
- UHC-48927-65
- Date of birth
- 1954-08-19
- Identity
- Verified6 records, confidence 0.99
- Claim record
- CLMCLM-421653
- Relationship
- Self, Mesa, AZ
Coverage and accumulators
Found by member ID
- Plan
- MEDICARE-ADV-B MA group GRP-9467
- Coverage period
- 2025-01-01 to present
- Deductible
- $2,240.36 of $2,500.0090%
- Out-of-pocket maximum
- $2,234.20 of $5,000.0045%
- Copays
- office $20.00, specialist $40.00, emergency $350.00
- Physical therapy visits
- 4 of 20 used
Provider
Billing and rendering
- Billing provider
- Meadow Cardiovascular AssociatesCardiology · taxonomy 207RC0000X
- NPI
- 8180484478
- Network
- In network
- Rendering NPI
- 7380559139
- Location
- Scottsdale, AZ · TIN 33-6309233
- Authorisation / referral
- none / none
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 | $572.00 | $314.60 | $270.63 | $43.97 | Paid |
| Totals | $572.00 | $314.60 | $270.63 | $43.97 | ||||||
- 1. I10 Essential (primary) hypertensionprincipal
- Patient account
- PA-103902
- 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-027302 (verified, link confidence 0.99). | |
| Eligibility | Pass | Active on 2026-08-19: MEDICARE-ADV-B (MA), effective 2025-01-01. | |
| Timely filing | Pass | Received 33 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 Associates2026-08-19 16:51
Patient seen for essential (primary) hypertension.
Attachments
Documents received with the claim
- Itemized billitemized_PA-103902.pdf8 pages
Itemised statement totalling $572.00 across 1 line.
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-2026-029709 | 2026-08-19 | Meadow Cardiovascular Associates | $572.00 | Denied |
| CLM-2026-027821 | 2026-07-04 | Harbor Medical Group | $724.00 | Approved |
| CLM-2026-005445 | 2026-07-04 | Canyon Medical Group | $363.00 | Approved |
| CLM-2026-015232 | 2026-03-11 | Valley Medical Group | $528.00 | 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.