Claims
Claims workbench
Every claim is attached to a resolved member identity, checked by the rules engine under CLAIMS-ADJ v1 (version 1), priced, and either finalised, pended, or handed to the AI adjudicator and an examiner.
Claims received
34,646
$54,707,511.00 billed
Needs review
3,664
50 with an AI recommendation
Pended
2,586
awaiting information or identity
Approved
23,942
$6,757,768.45 plan paid
Denied
4,454
with remittance reason codes
Examiner decided
0
167 not attached to an identity
| Claim | Member | Service | Provider | Procedures | Billed | Plan pays | Rules | AI | Status |
|---|---|---|---|---|---|---|---|---|---|
| CLM-2026-024097 UB-04 · 2026-10-18 | Christine Wright UHC-27440-91 | 2026-09-15 Outpatient hospital | Heritage Digestive Health Center Gastroenterology · in network | 45378, 88305 | $1,824.00 | — | Denied by rule CO27 | — | Denied |
| CLM-2026-004216 UB-04 · 2026-10-18 | Alexander Reid UHC-77022-69 | 2026-09-16 Outpatient hospital | Lakeside Imaging Center Radiology · in network | 71046, 70553 | $3,057.00 | — | Denied by rule CO27 | — | Denied |
| CLM-2026-001208 UB-04 · 2026-10-18 | Alexander Robertson UHC-20832-08 | 2026-09-29 Outpatient hospital | Cornerstone Bone and Joint Center Orthopedic Surgery · in network | 29881 | $10,651.00 | — | Denied by rule CO27 | — | Denied |
| CLM-2026-015188 UB-04 · 2026-10-17 | Jacqueline Willis UHC-69078-97 | 2026-09-29 Outpatient hospital | Sunrise Imaging Center Radiology · out of network | 76700, 74177 | $2,395.00 | — | Denied by rule CO27 | — | Denied |
| CLM-2026-004662 UB-04 · 2026-10-17 | Juan Franklin UHC-92188-10 | 2026-09-05 Outpatient hospital | Meadow Heart Institute Cardiology · in network | 93306, 93015 | $1,817.00 | — | Denied by rule CO27 | — | Denied |
| CLM-2026-027414 UB-04 · 2026-10-15 | Gregory Hunt UHC-84710-60 | 2026-09-23 Outpatient hospital | Pinecrest Bone and Joint Center Orthopedic Surgery · in network | 29881 | $6,359.00 | — | Denied by rule CO27 | — | Denied |
| CLM-2026-018854 UB-04 · 2026-10-15 | Gloria Yang UHC-77975-62 | 2026-10-07 Outpatient hospital | Northgate Heart Institute Cardiology · in network | 93458, 93306 | $10,394.00 | — | Denied by rule CO27 | — | Denied |
| CLM-2026-029540 UB-04 · 2026-10-14 | Mary Munz UHC-13183-92 | 2026-10-10 Outpatient hospital | Heritage GI Associates Gastroenterology · in network | 43239, 45378 | $4,347.00 | — | Denied by rule CO27 | — | Denied |
| CLM-2026-026234 UB-04 · 2026-10-14 | Victoria Richards UHC-93067-18 | 2026-09-04 Outpatient hospital | Cornerstone Imaging Center Radiology · in network | 77067, 74177, 71046 | $2,873.00 | — | Denied by rule CO27 | — | Denied |
| CLM-2026-011031 UB-04 · 2026-10-14 | Omar Hunt UHC-97434-51 | 2026-10-03 Outpatient hospital | Heritage Imaging Center Radiology · in network | 76700, 70553 | $3,006.00 | — | Denied by rule CO27 | — | Denied |
| CLM-2026-026211 UB-04 · 2026-10-13 | Judy Wells UHC-84471-03 | 2026-10-10 Outpatient hospital | Sunrise Imaging Center Radiology · in network | 70553, 74177 | $5,764.00 | — | Denied by rule CO27 | — | Denied |
| CLM-2026-028562 UB-04 · 2026-10-11 | Douglas Kim UHC-49616-13 | 2026-09-29 Emergency room | Heritage Community Hospital Emergency Medicine · in network | 99285 | $1,664.00 | — | Denied by rule CO27 | — | Denied |
| CLM-2026-024112 UB-04 · 2026-10-11 | Daniel Thomas UHC-78647-56 | 2026-09-09 Outpatient hospital | Riverside Diagnostic Imaging Radiology · in network | 74177, 77067 | $2,456.00 | — | Denied by rule CO27 | — | Denied |
| CLM-2026-029178 UB-04 · 2026-10-10 | Lucia Soto UHC-71796-85 | 2026-09-15 Outpatient hospital | Meadow Bone and Joint Center Orthopedic Surgery · in network | 70553, 73721 | $5,854.00 | — | Denied by rule CO27 | — | Denied |
| CLM-2026-001629 UB-04 · 2026-10-10 | Keith Bell UHC-34516-56 | 2026-08-30 Outpatient hospital | Meadow GI Associates Gastroenterology · in network | 88305 | $270.00 | — | Denied by rule CO27 | — | Denied |
| CLM-2026-016092 UB-04 · 2026-10-09 | Isabella Williams UHC-55456-26 | 2026-09-13 Outpatient hospital | Canyon Diagnostic Imaging Radiology · in network | 71046, 74177 | $2,579.00 | — | Denied by rule CO27 | — | Denied |
| CLM-2026-011074 UB-04 · 2026-10-09 | Anna Harvey UHC-53608-54 | 2026-09-15 Outpatient hospital | Meadow GI Associates Gastroenterology · out of network | 45378, 43239 | $4,163.00 | — | Denied by rule CO27 CO204 | — | Denied |
| CLM-2026-033093 UB-04 · 2026-10-08 | Jacob Cooper UHC-27394-07 | 2026-09-30 Outpatient hospital | Sunrise Digestive Health Center Gastroenterology · in network | 88305 | $311.00 | — | Denied by rule CO27 | — | Denied |
| CLM-2026-006128 UB-04 · 2026-10-08 | Karen Wong UHC-75927-48 | 2026-08-29 Outpatient hospital | Riverside Diagnostic Imaging Radiology · in network | 71046, 76700 | $692.00 | — | Denied by rule CO27 | — | Denied |
| CLM-2026-024401 UB-04 · 2026-10-07 | Brandon Boyd UHC-74380-08 | 2026-09-26 Emergency room | Canyon Community Hospital Emergency Medicine · out of network | 99284 | $1,478.00 | — | Denied by rule CO27 | — | Denied |
| CLM-2026-009890 UB-04 · 2026-10-07 | Albert Olson UHC-39661-50 | 2026-09-16 Inpatient hospital | Valley Bone and Joint Center Orthopedic Surgery · out of network | 27447 | $51,724.00 | — | Denied by rule CO27 | — | Denied |
| CLM-2026-031973 UB-04 · 2026-10-06 | Jean Lawrence UHC-43612-23 | 2026-08-30 Inpatient hospital | Pinecrest Medical Group Internal Medicine · in network | 99232 | $161.00 | — | Denied by rule CO27 | — | Denied |
| CLM-2026-020678 UB-04 · 2026-10-06 | Grace Vazquez UHC-00903-59 | 2026-09-19 Outpatient hospital | Riverside Diagnostic Imaging Radiology · in network | 77067, 70553 | $2,398.00 | — | Denied by rule CO27 | — | Denied |
| CLM-2026-015755 UB-04 · 2026-10-06 | Larry Hamilton UHC-53343-08 | 2026-09-15 Outpatient hospital | Riverside Digestive Health Center Gastroenterology · in network | 88305, 45378 | $2,324.00 | — | Denied by rule CO27 | — | Denied |
| CLM-2026-008695 UB-04 · 2026-10-06 | Bobby Santos UHC-83369-97 | 2026-09-16 Emergency room | Harbor Regional Medical Center Emergency Medicine · in network | 71046, 99284 | $1,735.00 | — | Denied by rule CO27 | — | Denied |
| CLM-2026-029909 UB-04 · 2026-10-05 | Logan Bell UHC-88125-05 | 2026-09-11 Outpatient hospital | Valley Reference Lab Clinical Laboratory · in network | 70553 | $3,426.00 | — | Denied by rule CO27 | — | Denied |
| CLM-2026-024380 UB-04 · 2026-10-05 | Elijah Aguilar UHC-11836-39 | 2026-09-14 Outpatient hospital | Unity Imaging Center Radiology · out of network | 71046, 70553 | $2,673.00 | — | Denied by rule CO27 CO204 | — | Denied |
| CLM-2026-021337 UB-04 · 2026-10-05 | Nicole Watkins UHC-16399-53 | 2026-09-23 Outpatient hospital | Sunrise Imaging Center Radiology · in network | 70553 | $2,968.00 | — | Denied by rule CO27 | — | Denied |
| CLM-2026-007602 UB-04 · 2026-10-05 | William Stevens UHC-98045-07 | 2026-09-05 Outpatient hospital | Desert Internal Medicine Associates Internal Medicine · in network | 70553 | $2,464.00 | — | Denied by rule CO27 | — | Denied |
| CLM-2026-025992 UB-04 · 2026-10-04 | Raymond Banks UHC-72994-01 | 2026-09-29 Outpatient hospital | Pinecrest Diagnostic Imaging Radiology · in network | 76700, 71046 | $706.00 | — | Denied by rule CO27 | — | Denied |
| CLM-2026-025429 UB-04 · 2026-10-04 | Jordan Wheeler UHC-10993-15 | 2026-08-31 Inpatient hospital | Northgate Internal Medicine Associates Internal Medicine · in network | 99232 | $214.00 | — | Denied by rule CO27 | — | Denied |
| CLM-2026-010776 UB-04 · 2026-10-04 | Hiroshi Martinez UHC-21659-34 | 2026-09-11 Inpatient hospital | Valley Bone and Joint Center Orthopedic Surgery · out of network | 27447 | $51,314.00 | — | Denied by rule CO27 CO204 | — | Denied |
| CLM-2026-020342 UB-04 · 2026-10-03 | Marcus Gardner UHC-24243-44 | 2026-09-16 Outpatient hospital | Valley Imaging Center Radiology · in network | 71046, 77067, 74177 | $2,574.00 | — | Denied by rule CO27 | — | Denied |
| CLM-2026-020112 UB-04 · 2026-10-03 | James Thompson UHC-57559-48 | 2026-09-05 Inpatient hospital | Mesa Internal Medicine Associates Internal Medicine · in network | 99232 | $253.00 | — | Denied by rule CO27 | — | Denied |
| CLM-2026-012145 UB-04 · 2026-10-03 | Camila Wang UHC-11506-03 | 2026-08-20 Outpatient hospital | Riverside Orthopedic Specialists Orthopedic Surgery · in network | 29881 | $9,249.00 | — | Denied by rule CO27 | — | Denied |
| CLM-2026-006425 UB-04 · 2026-10-03 | Robert Perkins UHC-38217-24 | 2026-09-23 Emergency room | Cornerstone Regional Medical Center Emergency Medicine · in network | 96374, 71046 | $365.00 | — | Denied by rule CO27 | — | Denied |
| CLM-2026-001345 UB-04 · 2026-10-03 | Alan Pierce UHC-35222-28 | 2026-09-15 Outpatient hospital | Valley Imaging Center Radiology · in network | 76700, 77067 | $782.00 | — | Denied by rule CO27 | — | Denied |
| CLM-2026-007090 UB-04 · 2026-10-01 | Brenda Turner UHC-44384-04 | 2026-08-20 Outpatient hospital | Sunrise Cardiovascular Associates Cardiology · in network | 93458 | $6,974.00 | — | Denied by rule CO27 | — | Denied |
| CLM-2026-034052 UB-04 · 2026-09-30 | Keith Gordon UHC-57784-50 | 2026-09-18 Outpatient hospital | Cornerstone Bone and Joint Center Orthopedic Surgery · in network | 29881 | $5,831.00 | — | Denied by rule CO27 | — | Denied |
| CLM-2026-028305 UB-04 · 2026-09-30 | Helen Patel UHC-69833-28 | 2026-09-21 Outpatient hospital | Meadow Imaging Center Radiology · in network | 74177 | $1,483.00 | — | Denied by rule CO27 | — | Denied |
| CLM-2026-027047 UB-04 · 2026-09-29 | Christian Carter UHC-93847-10 | 2026-09-03 Outpatient hospital | Canyon Diagnostic Imaging Radiology · in network | 71046, 70553 | $2,301.00 | — | Denied by rule CO27 | — | Denied |
| CLM-2026-027612 UB-04 · 2026-09-26 | Douglas Cole UHC-11333-58 | 2026-09-08 Emergency room | Meadow Regional Medical Center Emergency Medicine · in network | 99285 | $2,976.00 | — | Denied by rule CO27 | — | Denied |
| CLM-2026-023842 UB-04 · 2026-09-26 | Katherine Lucas UHC-29115-96 | 2026-08-23 Emergency room | Summit Regional Medical Center Emergency Medicine · in network | 99284 | $1,636.00 | — | Denied by rule CO27 | — | Denied |
| CLM-2026-021084 UB-04 · 2026-09-26 | Judy Burns UHC-13174-98 | 2026-08-13 Outpatient hospital | Pinecrest Bone and Joint Center Orthopedic Surgery · in network | 29881 | $9,739.00 | — | Denied by rule CO27 | — | Denied |
| CLM-2026-008868 UB-04 · 2026-09-26 | Brandon Alvarado UHC-74312-02 | 2026-08-16 Inpatient hospital | Meadow Medical Group Internal Medicine · in network | 99232 | $241.00 | — | Denied by rule CO27 | — | Denied |
| CLM-2026-017935 UB-04 · 2026-09-25 | Jesse Kim UHC-52083-96 | 2026-08-26 Outpatient hospital | Unity Medical Group Family Medicine · in network | 70553 | $2,621.00 | — | Denied by rule CO27 | — | Denied |
| CLM-2026-007058 UB-04 · 2026-09-25 | Bubby Colilns UHC-46738-01 | 2026-09-01 Emergency room | Summit Community Hospital Emergency Medicine · in network | 99285 | $2,122.00 | — | Denied by rule CO27 | — | Denied |
| CLM-2026-030139 UB-04 · 2026-09-24 | Heather Lopez UHC-55811-29 | 2026-08-14 Outpatient hospital | Pinecrest Diagnostic Imaging Radiology · in network | 74177 | $2,246.00 | — | Denied by rule CO27 | — | Denied |
| CLM-2026-025742 UB-04 · 2026-09-24 | Elizabeth Reyes UHC-73785-46 | 2026-08-19 Emergency room | Riverside Community Hospital Emergency Medicine · in network | 99284, 99283, 96374 | $2,660.00 | — | Denied by rule CO27 | — | Denied |
| CLM-2026-002664 UB-04 · 2026-09-24 | Diana Ryan UHC-42761-74 | 2026-09-02 Outpatient hospital | Evergreen GI Associates Gastroenterology · in network | 88305 | $270.00 | — | Denied by rule CO27 | — | Denied |
Top reason codes
Across rules and final decisions
- N30 Patient ineligible for this service1,566
- IDQ Member identity under steward review1,522
- CO50 Not medically necessary per payer policy1,234
- CO204 Service not covered under the member's plan1,223
- CO27 Expenses incurred after coverage terminated1,164
- CO18 Exact duplicate claim or service871
- CO97 Benefit included in another service already adjudicated608
- CO16 Claim lacks information needed for adjudication606
- CO29 Time limit for filing has expired589
- REPL Replacement claim; supersedes the original submission490
- CO197 Precertification or authorization absent481
- HIGH Billed amount above auto-pay ceiling351
How a claim is adjudicated
Deterministic first, AI second, people last
- Attach. The claim's member record is resolved through the identity graph; coverage is found by member ID or, failing that, by name and date of birth.
- Rules. Identity hold, eligibility, timely filing, duplicates, prior authorisation, network, medical-necessity edits, bundling, benefit limits, completeness and the high-dollar ceiling.
- Price. Contract or out-of-network allowance, then copay, deductible and coinsurance from the member's accumulators.
- AI review. Only claims the rules left for review go to the model, with every piece of evidence labelled. Its answer is validated before anyone sees it.
- Examiner. A person records the final decision with reason codes and a rationale; everything is hash-chained in the audit log.