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
3,663
89 with an AI recommendation
Pended
2,587
awaiting information or identity
Approved
23,942
$6,757,768.45 plan paid
Denied
4,454
with remittance reason codes
Examiner decided
1
167 not attached to an identity
| Claim | Member | Service | Provider | Procedures | Billed | Plan pays | Rules | AI | Status |
|---|---|---|---|---|---|---|---|---|---|
| CLM-2026-024408 UB-04 · 2026-01-09 | Nancy Price UHC-34209-49 | 2026-01-01 Emergency room | Riverside Regional Medical Center Emergency Medicine · out of network | 96374, 99283 | $1,206.00 | — | Left for review NET | Approved confidence 0.95 | Needs review |
| CLM-2026-032646 UB-04 · 2026-01-08 | Camila Rios UHC-12493-59 | 2025-12-13 Outpatient hospital | Mesa Bone and Joint Center Orthopedic Surgery · in network | 70553, 73721 | $3,864.00 | — | Left for review CO50 | Approved confidence 0.95 | Needs review |
| CLM-2026-030098 UB-04 · 2026-01-08 | Joyce Carter UHC-28186-60 | 2025-11-29 Outpatient hospital | Evergreen Medical Group Family Medicine · in network | 70553 | $2,667.00 | — | Left for review CO50 | Denied confidence 0.95 | Needs review |
| CLM-2026-028277 UB-04 · 2026-01-08 | Gary Matthews UHC-27209-51 | 2025-12-19 Outpatient hospital | Northgate Imaging Center Radiology · out of network | 74177 | $1,935.00 | — | Left for review CO16 | Pended confidence 0.80 | Needs review |
| CLM-2026-017072 UB-04 · 2026-01-08 | Emma Henry UHC-50050-99 | 2025-12-01 Inpatient hospital | Mesa Orthopedic Specialists Orthopedic Surgery · in network | 27447 | $32,757.00 | — | Left for review HIGH | Approved confidence 0.95 | Needs review |
| CLM-2026-015936 UB-04 · 2026-01-08 | Peter Kelly UHC-28833-25 | 2025-12-15 Outpatient hospital | Northgate Imaging Center Radiology · out of network | 76700, 74177 | $2,069.00 | — | Left for review CO50 | Pended confidence 0.80 | Needs review |
| CLM-2026-015028 UB-04 · 2026-01-08 | Emma Simpson UHC-49747-10 | 2025-12-23 Outpatient hospital | Sunrise Imaging Center Radiology · out of network | 76700, 70553 | $2,822.00 | — | Left for review CO50 | Pended confidence 0.80 | Needs review |
| CLM-2026-012810 UB-04 · 2026-01-08 | Patricia Le UHC-15651-83 | 2025-12-11 Inpatient hospital | Sunrise Internal Medicine Associates Internal Medicine · in network | 99232, 99215 | $503.00 | — | Left for review CO97 | Denied confidence 0.95 | Needs review |
| CLM-2026-011954 UB-04 · 2026-01-08 | Diana Carroll UHC-85368-85 | 2026-01-02 Outpatient hospital | Lakeside Skin Care Associates Dermatology · in network | 70553 | $2,654.00 | — | Left for review CO50 | Approved confidence 0.95 | Needs review |
| CLM-2026-029085 UB-04 · 2026-01-07 | Cynthia Hunter UHC-66546-30 | 2025-12-28 Outpatient hospital | Northgate Heart Institute Cardiology · in network | 70553 | $2,420.00 | — | Left for review CO50 | Approved confidence 0.95 | Needs review |
| CLM-2026-027610 UB-04 · 2026-01-07 | Dorothy Fulelr UHC-32368-14 | 2025-12-15 Outpatient hospital | Lakeside Imaging Center Radiology · in network | 70553 | $1,862.00 | — | Left for review CO50 | Approved confidence 0.95 | Needs review |
| CLM-2026-027283 UB-04 · 2026-01-07 | Eugene Evans UHC-97992-74 | 2025-12-17 Outpatient hospital | Canyon Medical Group Internal Medicine · in network | 70553 | $2,600.00 | — | Left for review CO50 | Denied confidence 0.95 | Needs review |
| CLM-2026-020306 UB-04 · 2026-01-07 | Mateo Sims UHC-98861-75 | 2025-11-24 Outpatient hospital | Lakeside Skin Care Associates Dermatology · in network | 70553 | $2,404.00 | — | Left for review CO50 | Denied confidence 0.95 | Needs review |
| CLM-2026-020258 UB-04 · 2026-01-07 | Larry Perez UHC-26253-85 | 2025-12-01 Inpatient hospital | Lakeside Bone and Joint Center Orthopedic Surgery · in network | 27447 | $48,120.00 | — | Left for review HIGH | Approved confidence 0.95 | Needs review |
| CLM-2026-011193 UB-04 · 2026-01-07 | Lisa Graham UHC-27955-94 | 2025-12-05 Inpatient hospital | Lakeside Orthopedic Specialists Orthopedic Surgery · in network | 27447 | $45,350.00 | — | Left for review HIGH | Approved confidence 0.95 | Needs review |
| CLM-2026-002281 UB-04 · 2026-01-07 | Andrew Harper UHC-15603-56 | 2025-12-25 Inpatient hospital | Northgate Bone and Joint Center Orthopedic Surgery · out of network | 27447 | $47,343.00 | — | Left for review HIGH | Approved confidence 0.95 | Needs review |
| CLM-2026-033567 UB-04 · 2026-01-06 | Philip Holmes UHC-83762-30 | 2025-12-22 Outpatient hospital | Canyon Regional Medical Center Emergency Medicine · in network | 70553 | $3,435.00 | — | Left for review CO50 | Approved confidence 0.95 | Needs review |
| CLM-2026-026357 UB-04 · 2026-01-06 | Grace Valdez UHC-35478-16 | 2025-12-17 Outpatient hospital | Summit Cardiovascular Associates Cardiology · in network | 70553 | $3,501.00 | — | Left for review CO50 | Denied confidence 0.95 | Needs review |
| CLM-2026-024024 UB-04 · 2026-01-06 | Teresa Howell UHC-92058-49 | 2025-12-25 Inpatient hospital | Cornerstone Bone and Joint Center Orthopedic Surgery · in network | 27447 | $32,041.00 | — | Left for review HIGH | Approved confidence 0.95 | Needs review |
| CLM-2026-023750 UB-04 · 2026-01-06 | Matthew Ward UHC-15822-54 | 2025-12-27 Emergency room | Valley Regional Medical Center Emergency Medicine · in network | 71046, 99283, 99284 | $2,043.00 | — | Left for review CO97 | Denied confidence 0.95 | Needs review |
| CLM-2026-022823 UB-04 · 2026-01-06 | Carl Rivera UHC-16910-17 | 2025-12-22 Outpatient hospital | Unity Medical Group Internal Medicine · in network | 70553 | $3,569.00 | — | Left for review CO50 | Approved confidence 0.95 | Needs review |
| CLM-2026-011814 UB-04 · 2026-01-06 | Patricia Sandoval UHC-68939-94 | 2025-12-15 Outpatient hospital | Meadow Physical Therapy Physical Therapy · out of network | 70553 | $4,716.00 | — | Left for review CO50 | Denied confidence 0.95 | Needs review |
| CLM-2026-008128 UB-04 · 2026-01-06 | Gregory Reid UHC-65879-07 | 2025-12-06 Emergency room | Mesa Regional Medical Center Emergency Medicine · out of network | 99284, 99283 | $2,491.00 | — | Left for review NET | Approved confidence 0.95 | Needs review |
| CLM-2026-003253 UB-04 · 2026-01-06 | Gabriel Robertson UHC-65311-64 | 2025-12-25 Outpatient hospital | Desert Internal Medicine Associates Internal Medicine · in network | 70553 | $2,210.00 | — | Left for review CO50 | Denied confidence 0.95 | Needs review |
| CLM-2026-032124 UB-04 · 2026-01-05 | Bryan McDonald UHC-55577-57 | 2025-12-08 Outpatient hospital | Unity Medical Group Family Medicine · in network | 70553 | $2,231.00 | — | Left for review CO50 | Approved confidence 0.95 | Needs review |
| CLM-2026-024777 UB-04 · 2026-01-05 | Amanda Mendoza UHC-89922-24 | 2025-12-14 Outpatient hospital | Meadow Regional Medical Center Emergency Medicine · in network | 70553 | $3,089.00 | — | Left for review CO50 | Denied confidence 0.95 | Needs review |
| CLM-2026-009416 UB-04 · 2026-01-05 | Joseph Flores UHC-70640-04 | 2025-12-04 Outpatient hospital | Northgate Medical Group Family Medicine · in network | 70553 | $2,513.00 | — | Left for review CO50 | Approved confidence 0.95 | Needs review |
| CLM-2026-007671 UB-04 · 2026-01-05 | Tyler Morris UHC-22612-53 | 2025-12-20 Outpatient hospital | Harbor Rehabilitation Center Physical Therapy · in network | 70553 | $9,804.00 | — | Left for review CO50 | Denied confidence 0.95 | Needs review |
| CLM-2026-005011 UB-04 · 2026-01-05 | Maria Meyer UHC-73025-52 | 2025-11-21 Outpatient hospital | Summit Regional Medical Center Emergency Medicine · in network | 70553 | $3,280.00 | — | Left for review CO50 | Approved confidence 0.95 | Needs review |
| CLM-2026-026866 UB-04 · 2026-01-04 | Stephen Lewis UHC-80754-67 | 2025-11-28 Outpatient hospital | Northgate Internal Medicine Associates Internal Medicine · in network | 70553 | $2,149.00 | — | Left for review CO50 | Denied confidence 0.95 | Needs review |
| CLM-2026-025089 UB-04 · 2026-01-04 | Katherie Le UHC-75014-19 | 2025-11-27 Outpatient hospital | Meadow Family Practice Family Medicine · in network | 70553 | $3,531.00 | — | Left for review CO50 | Approved confidence 0.95 | Needs review |
| CLM-2026-021384 UB-04 · 2026-01-04 | Jose Mejia UHC-36493-03 | 2025-12-01 Inpatient hospital | Mesa Orthopedic Specialists Orthopedic Surgery · out of network | 27447 | $34,233.00 | — | Left for review HIGH | Approved confidence 0.95 | Needs review |
| CLM-2026-016865 UB-04 · 2026-01-04 | Douglas Howell UHC-59326-05 | 2025-12-13 Outpatient hospital | Northgate Cardiovascular Associates Cardiology · in network | 93458 | $7,608.00 | — | Left for review CO197 | Pended confidence 0.95 | Needs review |
| CLM-2026-016227 UB-04 · 2026-01-04 | Gerald Miller UHC-84890-95 | 2025-11-22 Emergency room | Desert Regional Medical Center Emergency Medicine · in network | 96374 | $213.00 | — | Left for review CO16 | Pended confidence 0.95 | Needs review |
| CLM-2026-010460 UB-04 · 2026-01-04 | Lawrence Morgan UHC-08471-65 | 2025-12-12 Outpatient hospital | Heritage Internal Medicine Associates Internal Medicine · in network | 70553 | $2,802.00 | — | Left for review CO50 | Pended confidence 0.80 | Needs review |
| CLM-2026-009009 UB-04 · 2026-01-04 | Bryan McDonald UHC-55577-57 | 2025-12-20 Outpatient hospital | Pinecrest Reference Lab Clinical Laboratory · in network | 70553 | $2,869.00 | — | Left for review CO50 | Pended confidence 0.80 | Needs review |
| CLM-2026-024461 UB-04 · 2026-01-03 | Nicole Henderson UHC-56732-85 | 2025-12-10 Outpatient hospital | Sunrise Diagnostic Imaging Radiology · in network | 74177, 70553, 77067 | $5,221.00 | — | Left for review CO50 CO97 | Denied confidence 0.95 | Needs review |
| CLM-2026-011863 UB-04 · 2026-01-03 | Yuki Herrera UHC-52366-24 | 2025-12-23 Outpatient hospital | Desert Medical Group Internal Medicine · in network | 70553 | $3,554.00 | — | Left for review CO50 | Approved confidence 0.95 | Needs review |
| CLM-2026-006650 UB-04 · 2026-01-03 | Jon Parker UHC-53297-26 | 2025-12-27 Outpatient hospital | Evergreen Diagnostic Imaging Radiology · in network | 70553, 74177 | $5,726.00 | — | Left for review CO97 | Denied confidence 0.95 | Needs review |
| CLM-2026-030759 UB-04 · 2026-01-02 | Gregory Taylor UHC-40403-19 | 2025-12-31 Outpatient hospital | Meadow Imaging Center Radiology · in network | 70553, 76700, 74177 | $4,904.00 | — | Left for review CO16 | Pended confidence 0.95 | Needs review |
| CLM-2026-028677 UB-04 · 2026-01-02 | Ashley Olson UHC-54563-08 | 2025-12-27 Outpatient hospital | Unity Counseling Center Behavioral Health · in network | 70553 | $2,607.00 | — | Left for review CO50 | Approved confidence 0.95 | Needs review |
| CLM-2026-022907 UB-04 · 2026-01-02 | Amanda Fisher UHC-11517-28 | 2025-11-26 Outpatient hospital | Lakeside Clinical Laboratories Clinical Laboratory · in network | 70553 | $2,835.00 | — | Left for review CO50 | Approved confidence 0.95 | Needs review |
| CLM-2026-015314 UB-04 · 2026-01-02 | Albert Burton UHC-66153-74 | 2025-12-25 Outpatient hospital | Mesa Imaging Center Radiology · out of network | 70553 | $2,589.00 | — | Left for review CO50 | Denied confidence 0.95 | Needs review |
| CLM-2026-012816 UB-04 · 2026-01-02 | Ruth Pierce UHC-19964-20 | 2025-12-26 Outpatient hospital | Harbor Bone and Joint Center Orthopedic Surgery · in network | 29881 | $5,855.00 | — | Left for review CO197 | Pended confidence 0.95 | Needs review |
| CLM-2026-008433 UB-04 · 2026-01-02 | Martha Weaver UHC-63216-91 | 2025-11-27 Outpatient hospital | Meadow Imaging Center Radiology · in network | 74177, 70553 | $4,179.00 | — | Left for review CO97 | Approved confidence 0.95 | Needs review |
| CLM-2026-003506 UB-04 · 2026-01-02 | Joshua Holmes UHC-28099-06 | 2025-12-24 Outpatient hospital | Northgate Cardiovascular Associates Cardiology · in network | 70553 | $2,968.00 | — | Left for review CO50 | Denied confidence 0.95 | Needs review |
| CLM-2026-003303 UB-04 · 2026-01-02 | Jennifer Vargas UHC-26130-42 | 2025-11-19 Outpatient hospital | Unity Reference Lab Clinical Laboratory · in network | 70553 | $2,302.00 | — | Left for review CO50 | Approved confidence 0.95 | Needs review |
| CLM-2026-030071 UB-04 · 2026-01-01 | Luis Carlson UHC-63765-77 | 2025-12-29 Outpatient hospital | Sunrise Community Hospital Emergency Medicine · in network | 70553 | $3,173.00 | — | Left for review CO50 | Denied confidence 0.95 | Needs review |
| CLM-2026-029989 UB-04 · 2026-01-01 | Marilyn Fisher UHC-53466-53 | 2025-12-06 Inpatient hospital | Mesa Orthopedic Specialists Orthopedic Surgery · out of network | 27447 | $49,523.00 | — | Left for review HIGH | Approved confidence 0.95 | Needs review |
| CLM-2026-029899 UB-04 · 2026-01-01 | Henry Ward UHC-63253-17 | 2025-12-13 Outpatient hospital | Heritage Internal Medicine Associates Internal Medicine · in network | 70553 | $3,356.00 | — | Left for review CO50 | Denied confidence 0.95 | Needs review |
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.