CLM-2026-033389
Meadow Cardiovascular Associates, Cardiology. Service 2025-10-18 at outpatient hospital (POS 22). Received 2026-03-12.
Member
Resolved through the identity graph
- Member
- Ann Perez
- Member ID
- UHC-58834-40
- Date of birth
- 1993-08-11
- Identity
- Verified5 records, confidence 0.99
- Claim record
- CLMCLM-431918
- Relationship
- Self, Phoenix, AZ
Coverage and accumulators
Found by member ID
- Plan
- CORE-HMO HMO group GRP-6900
- Coverage period
- 2022-02-01 to present
- Deductible
- $952.35 of $1,500.0063%
- Out-of-pocket maximum
- $1,332.17 of $6,000.0022%
- Copays
- office $30.00, specialist $60.00, emergency $250.00
- Physical therapy visits
- 14 of 20 used
Provider
Billing and rendering
- Billing provider
- Meadow Cardiovascular AssociatesCardiology · taxonomy 207RC0000X
- NPI
- 2145896462
- Network
- In network
- Rendering NPI
- 7456343434
- Location
- Scottsdale, AZ · TIN 58-0592913
- Authorisation / referral
- PA2025298029 / REF204235
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 | $5,413.00 | $2,977.15 | — | — | DeniedCO29 |
| Totals | $5,413.00 | $2,977.15 | — | — | ||||||
- 1. R07.9 Chest pain, unspecifiedprincipal
- 2. I48.91 Unspecified atrial fibrillation
- Patient account
- PA-868057
- Frequency code
- 1 (original)
- Accident
- No
- DRG
- 287
- Admit / discharge
- —
- Landed
- 2026-10-22 12:44
Rules engine
CLAIMS-ADJ v1: 11 checks, 1 needing attention
| Check | Result | Code | Detail |
|---|---|---|---|
| Member identity | Pass | Attached to MBR-008820 (verified, link confidence 0.99). | |
| Eligibility | Pass | Active on 2025-10-18: CORE-HMO (HMO), effective 2022-02-01. | |
| Timely filing | Fail | CO29 | Received 145 days after the last date of service (limit 90). Time limit for filing has expired |
| Duplicate check | Pass | No matching prior claim in the duplicate window. | |
| Prior authorisation | Pass | Authorisation PA2025298029 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 Associates2025-10-18 14:38
Follow-up for chest pain, unspecified. Plan discussed, medications reconciled.
- SystemSystem: Claims system2026-03-12 05:02
Received more than 90 days after the last date of service. Check for a timely-filing waiver before finalising.
- AdministrativeExaminer: D. Okafor (Medical Director, MD)2026-03-12 08:05
Called the provider office; awaiting documentation.
Attachments
Documents received with the claim
- Prior auth letterPA2025298029_approval.pdf2 pages
Utilisation management approval letter for 93458 (Cardiac catheterisation, left heart), valid 2025-10-18 to 2026-01-16.
- Itemized billitemized_PA-868057.pdf3 pages
Itemised statement totalling $5413.00 across 1 line.
Claim history
Every event on this claim, sealed in the audit chain
- Rules engineDenied2026-10-22 12:44Timely filing: Received 145 days after the last date of service (limit 90).
Other claims for this member
Same resolved identity
| Claim | Service | Provider | Billed | Status |
|---|---|---|---|---|
| CLM-2026-004351 | 2026-07-22 | Canyon Cardiovascular Associates | $1,981.00 | 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
Received after the timely-filing limit.