CLM-2026-030256
Meadow Cardiovascular Associates, Cardiology. Service 2026-01-25 at outpatient hospital (POS 22). Received 2026-01-29.
Member
Resolved through the identity graph
- Member
- Judy Payne
- Member ID
- UHC-70825-08
- Date of birth
- 1950-01-20
- Identity
- Verified5 records, confidence 0.99
- Claim record
- CLMCLM-408467
- Relationship
- Self, Minneapolis, MN
Coverage and accumulators
Found by member ID
- Plan
- OPTIONS-PPO PPO group GRP-8253
- Coverage period
- 2021-06-01 to present
- Deductible
- $1,658.10 of $2,500.0066%
- Out-of-pocket maximum
- $4,446.42 of $10,000.0044%
- Copays
- office $30.00, specialist $40.00, emergency $150.00
- Physical therapy visits
- 15 of 20 used
Provider
Billing and rendering
- Billing provider
- Meadow Cardiovascular AssociatesCardiology · taxonomy 207RC0000X
- NPI
- 2145896462
- Network
- In network
- Rendering NPI
- 1375589409
- Location
- Scottsdale, AZ · TIN 58-0592913
- Authorisation / referral
- PA2026955410 / 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 | 93458 rev 0481 | Cardiac catheterisation, left heart | — | 1 | 1 | $7,416.00 | $4,078.80 | $1,165.59 | $2,913.21 | Paid |
| Totals | $7,416.00 | $4,078.80 | $1,165.59 | $2,913.21 | ||||||
- 1. R07.9 Chest pain, unspecifiedprincipal
- 2. I25.10 Atherosclerotic heart disease of native coronary artery without angina
- 3. I50.9 Heart failure, unspecified
- Patient account
- PA-762831
- Frequency code
- 1 (original)
- Accident
- No
- DRG
- 287
- 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-008585 (verified, link confidence 0.99). | |
| Eligibility | Pass | Active on 2026-01-25: OPTIONS-PPO (PPO), effective 2021-06-01. | |
| Timely filing | Pass | Received 4 days after service (limit 90). | |
| Duplicate check | Pass | No matching prior claim in the duplicate window. | |
| Prior authorisation | Pass | Authorisation PA2026955410 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 Associates2026-01-25 18:50
Follow-up for chest pain, unspecified. Plan discussed, medications reconciled.
Attachments
Documents received with the claim
- Prior auth letterPA2026955410_approval.pdf2 pages
Utilisation management approval letter for 93458 (Cardiac catheterisation, left heart), valid 2026-01-25 to 2026-04-25.
- Itemized billitemized_PA-762831.pdf7 pages
Itemised statement totalling $7416.00 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-2026-008361 | 2026-09-23 | Desert Diagnostic Imaging | $137.00 | Denied |
| CLM-2026-008360 | 2026-09-23 | Desert Diagnostic Imaging | $137.00 | Approved |
| CLM-2026-015161 | 2026-05-04 | Heritage Rehabilitation Center | $252.00 | Denied |
| CLM-2026-015160 | 2026-05-04 | Heritage Rehabilitation Center | $252.00 | 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.