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-2026-024368 UB-04 · 2026-10-18 | Omar Holmes UHC-04491-04 | 2026-09-27 Outpatient hospital | Unity Diagnostic Imaging Radiology · in network | 74177, 70553 | $5,077.00 | — | Left for review CO50 CO97 | — | Needs review |
| CLM-2026-024099 UB-04 · 2026-10-18 | Roger Bennett UHC-51537-03 | 2026-10-11 Outpatient hospital | Evergreen Digestive Health Center Gastroenterology · in network | 70553 | $3,498.00 | — | Left for review CO50 | — | Needs review |
| CLM-2026-023616 UB-04 · 2026-10-18 | Tyler Carter UHC-34633-94 | 2026-09-11 Outpatient hospital | Canyon Primary Care Associates Family Medicine · in network | 70553 | $3,097.00 | — | Left for review CO50 | — | Needs review |
| CLM-2026-023208 UB-04 · 2026-10-18 | Austin Li UHC-41620-28 | 2026-09-03 Outpatient hospital | Canyon Regional Medical Center Emergency Medicine · in network | 70553 | $2,294.00 | — | Left for review CO50 | — | Needs review |
| CLM-2026-018689 UB-04 · 2026-10-18 | Gabriel Sanders UHC-13138-62 | 2026-09-06 Outpatient hospital | Mesa Internal Medicine Associates Internal Medicine · in network | 70553 | $2,621.00 | — | Left for review CO50 | — | Needs review |
| CLM-2026-017328 UB-04 · 2026-10-18 | Jerry Edwards UHC-51204-16 | 2026-09-15 Outpatient hospital | Lakeside Internal Medicine Associates Internal Medicine · in network | 70553 | $2,954.00 | — | Left for review CO50 | — | Needs review |
| CLM-2026-016730 UB-04 · 2026-10-18 | Kathlean Silva UHC-59277-27 | 2026-09-12 Outpatient hospital | Pinecrest Bone and Joint Center Orthopedic Surgery · in network | 70553 | $3,592.00 | — | Left for review CO50 | — | Needs review |
| CLM-2026-028239 UB-04 · 2026-10-17 | Christopher Mendez UHC-78590-93 | 2026-10-01 Outpatient hospital | Meadow Regional Medical Center Emergency Medicine · in network | 70553 | $2,335.00 | — | Left for review CO50 | — | Needs review |
| CLM-2026-023184 UB-04 · 2026-10-17 | Joshua Campbell UHC-12728-30 | 2026-09-13 Outpatient hospital | Lakeside Imaging Center Radiology · in network | 74177 | $1,255.00 | — | Left for review CO50 | — | Needs review |
| CLM-2026-011706 UB-04 · 2026-10-17 | Tyler Silva UHC-89750-63 | 2026-09-26 Outpatient hospital | Unity Bone and Joint Center Orthopedic Surgery · in network | 70553 | $3,523.00 | — | Left for review CO50 | — | Needs review |
| CLM-2026-010982 UB-04 · 2026-10-17 | Deborah Ramos UHC-13452-14 | 2026-09-07 Outpatient hospital | Unity Clinical Laboratories Clinical Laboratory · in network | 70553 | $2,722.00 | — | Left for review CO50 | — | Needs review |
| CLM-2026-001809 UB-04 · 2026-10-17 | Timothy Myers UHC-88645-59 | 2026-09-11 Outpatient hospital | Desert Medical Group Internal Medicine · in network | 70553 | $2,478.00 | — | Left for review CO50 | — | Needs review |
| CLM-2026-000967 UB-04 · 2026-10-17 | Virginia Roberts UHC-23292-08 | 2026-10-09 Outpatient hospital | Heritage Imaging Center Radiology · in network | 74177 | $1,611.00 | — | Left for review CO50 | — | Needs review |
| CLM-2026-033094 UB-04 · 2026-10-16 | Alexander Rose UHC-33854-74 | 2026-10-12 Outpatient hospital | Evergreen Orthopedic Specialists Orthopedic Surgery · in network | 70553 | $3,192.00 | — | Left for review CO50 | — | Needs review |
| CLM-2026-032994 UB-04 · 2026-10-16 | Betty Stephens UHC-08557-91 | 2026-10-04 Outpatient hospital | Summit Medical Group Internal Medicine · in network | 70553 | $2,557.00 | — | Left for review CO50 | — | Needs review |
| CLM-2026-032345 UB-04 · 2026-10-16 | Carol Pierce UHC-80359-24 | 2026-10-11 Outpatient hospital | Mesa Bone and Joint Center Orthopedic Surgery · in network | 70553 | $2,131.00 | — | Left for review CO50 | — | Needs review |
| CLM-2026-019732 UB-04 · 2026-10-16 | Mason Hoffman UHC-12915-20 | 2026-10-05 Outpatient hospital | Riverside Imaging Center Radiology · in network | 70553, 74177 | $4,770.00 | — | Left for review CO50 | — | Needs review |
| CLM-2026-014114 UB-04 · 2026-10-16 | Joseph Flores UHC-55754-19 | 2026-09-27 Outpatient hospital | Evergreen Diagnostic Imaging Radiology · in network | 70553 | $3,583.00 | — | Left for review CO50 | — | Needs review |
| CLM-2026-030326 UB-04 · 2026-10-15 | Mateo Carlson UHC-62488-93 | 2026-10-06 Outpatient hospital | Meadow Physical Therapy Physical Therapy · in network | 70553 | $8,862.00 | — | Left for review CO50 | — | Needs review |
| CLM-2026-029535 UB-04 · 2026-10-15 | Jordan Gardner UHC-58120-60 | 2026-10-07 Outpatient hospital | Desert Diagnostic Imaging Radiology · in network | 74177 | $2,355.00 | — | Left for review CO50 | — | Needs review |
| CLM-2026-029162 UB-04 · 2026-10-15 | Albert Sanders UHC-40942-62 | 2026-09-08 Outpatient hospital | Riverside Family Practice Family Medicine · in network | 70553 | $2,255.00 | — | Left for review CO50 | — | Needs review |
| CLM-2026-022529 UB-04 · 2026-10-15 | Jesse Baker UHC-05897-89 | 2026-10-05 Outpatient hospital | Lakeside Imaging Center Radiology · in network | 70553, 71046 | $2,150.00 | — | Left for review CO50 | — | Needs review |
| CLM-2026-020313 UB-04 · 2026-10-15 | Samuel West UHC-29799-48 | 2026-10-10 Outpatient hospital | Meadow Primary Care Associates Family Medicine · in network | 70553 | $2,486.00 | — | Left for review CO50 | — | Needs review |
| CLM-2026-015970 UB-04 · 2026-10-15 | George Kelley UHC-50392-85 | 2026-10-01 Outpatient hospital | Valley Imaging Center Radiology · in network | 70553, 74177 | $4,486.00 | — | Left for review CO50 | — | Needs review |
| CLM-2026-015835 UB-04 · 2026-10-15 | Angela Sanders UHC-47771-45 | 2026-09-25 Outpatient hospital | Heritage Primary Care Associates Family Medicine · in network | 70553 | $2,840.00 | — | Left for review CO50 | — | Needs review |
| CLM-2026-014761 UB-04 · 2026-10-15 | Peterson Laura UHC-01699-49 | 2026-09-06 Outpatient hospital | Mesa Clinical Laboratories Clinical Laboratory · in network | 70553 | $3,003.00 | — | Left for review CO50 | — | Needs review |
| CLM-2026-012741 UB-04 · 2026-10-15 | Raymond Alvarado UHC-63639-31 | 2026-09-12 Outpatient hospital | Pinecrest Primary Care Associates Family Medicine · in network | 70553 | $3,358.00 | — | Left for review CO50 | — | Needs review |
| CLM-2026-030597 UB-04 · 2026-10-14 | Lori Santos UHC-54330-79 | 2026-09-17 Outpatient hospital | Mesa Dermatology Clinic Dermatology · in network | 70553 | $3,151.00 | — | Left for review CO50 | — | Needs review |
| CLM-2026-029740 UB-04 · 2026-10-14 | Bruce Garza UHC-63823-65 | 2026-09-12 Outpatient hospital | Riverside Diagnostic Imaging Radiology · in network | 74177, 71046 | $2,218.00 | — | Left for review CO50 | — | Needs review |
| CLM-2026-025174 UB-04 · 2026-10-14 | Katherine Stevens UHC-93932-26 | 2026-09-21 Outpatient hospital | Harbor Family Practice Family Medicine · in network | 70553 | $2,391.00 | — | Left for review CO50 | — | Needs review |
| CLM-2026-021995 UB-04 · 2026-10-14 | Logan Wang UHC-37033-56 | 2026-09-27 Outpatient hospital | Meadow Primary Care Associates Family Medicine · in network | 70553 | $1,963.00 | — | Left for review CO50 | — | Needs review |
| CLM-2026-016030 UB-04 · 2026-10-14 | Timothy Phillips UHC-10844-40 | 2026-08-31 Outpatient hospital | Lakeside Imaging Center Radiology · in network | 74177 | $1,779.00 | — | Left for review CO50 | — | Needs review |
| CLM-2026-008692 UB-04 · 2026-10-14 | Omar McCoy UHC-42002-69 | 2026-09-21 Outpatient hospital | Harbor Imaging Center Radiology · in network | 70553, 76700, 77067 | $3,572.00 | — | Left for review CO50 | — | Needs review |
| CLM-2026-025627 UB-04 · 2026-10-13 | Bradley Brown UHC-19081-69 | 2026-09-11 Outpatient hospital | Mesa Internal Medicine Associates Internal Medicine · in network | 70553 | $2,619.00 | — | Left for review CO50 | — | Needs review |
| CLM-2026-024708 UB-04 · 2026-10-13 | Heather Nichols UHC-39281-13 | 2026-08-30 Outpatient hospital | Meadow Imaging Center Radiology · in network | 70553, 76700 | $3,490.00 | — | Left for review CO50 | — | Needs review |
| CLM-2026-028827 UB-04 · 2026-10-12 | Ahmed Harper UHC-66686-95 | 2026-10-09 Outpatient hospital | Heritage Community Hospital Emergency Medicine · in network | 70553 | $2,352.00 | — | Left for review CO50 | — | Needs review |
| CLM-2026-027407 UB-04 · 2026-10-12 | Amy Medina UHC-94216-16 | 2026-10-07 Outpatient hospital | Unity Cardiovascular Associates Cardiology · in network | 70553, 93458 | $12,439.00 | — | Left for review CO50 | — | Needs review |
| CLM-2026-017685 UB-04 · 2026-10-12 | Steven Turner UHC-95158-61 | 2026-09-03 Outpatient hospital | Meadow Clinical Laboratories Clinical Laboratory · in network | 70553 | $2,890.00 | — | Left for review CO50 | — | Needs review |
| CLM-2026-007469 UB-04 · 2026-10-12 | Carl Hunt UHC-78785-52 | 2026-09-19 Outpatient hospital | Desert Primary Care Associates Family Medicine · in network | 70553 | $2,235.00 | — | Left for review CO50 | — | Needs review |
| CLM-2026-026856 UB-04 · 2026-10-11 | Megan Pena UHC-82997-21 | 2026-09-12 Outpatient hospital | Desert Imaging Center Radiology · in network | 70553 | $1,943.00 | — | Left for review CO50 | — | Needs review |
| CLM-2026-025452 UB-04 · 2026-10-11 | Jacqueline Bennett UHC-63718-39 | 2026-09-25 Outpatient hospital | Lakeside Internal Medicine Associates Internal Medicine · in network | 70553 | $3,279.00 | — | Left for review CO50 | — | Needs review |
| CLM-2026-021474 UB-04 · 2026-10-11 | Gerald Lynch UHC-99823-73 | 2026-09-22 Outpatient hospital | Riverside Imaging Center Radiology · in network | 70553, 76700 | $2,528.00 | — | Left for review CO50 | — | Needs review |
| CLM-2026-019726 UB-04 · 2026-10-11 | Douglas Ford UHC-73862-03 | 2026-09-18 Outpatient hospital | Sunrise Physical Therapy Physical Therapy · in network | 70553 | $7,038.00 | — | Left for review CO50 | — | Needs review |
| CLM-2026-012329 UB-04 · 2026-10-11 | Wayne Santiago UHC-95759-83 | 2026-09-20 Outpatient hospital | Heritage Family Practice Family Medicine · in network | 70553 | $2,586.00 | — | Left for review CO50 | — | Needs review |
| CLM-2026-000944 UB-04 · 2026-10-11 | Lori Roberts UHC-78605-17 | 2026-09-12 Outpatient hospital | Unity Community Hospital Emergency Medicine · in network | 70553 | $3,484.00 | — | Left for review CO50 | — | Needs review |
| CLM-2026-026627 UB-04 · 2026-10-10 | Arjun Hughes UHC-32299-75 | 2026-09-15 Outpatient hospital | Meadow Dermatology Clinic Dermatology · in network | 70553 | $1,808.00 | — | Left for review CO50 | — | Needs review |
| CLM-2026-010826 UB-04 · 2026-10-10 | Evelyn Wilson UHC-19839-19 | 2026-09-02 Outpatient hospital | Valley Imaging Center Radiology · in network | 70553, 71046 | $2,389.00 | — | Left for review CO50 CO16 | — | Needs review |
| CLM-2026-008060 UB-04 · 2026-10-10 | Judith Gomez UHC-71940-96 | 2026-10-06 Outpatient hospital | Unity Diagnostic Imaging Radiology · in network | 74177 | $1,310.00 | — | Left for review CO50 | — | Needs review |
| CLM-2026-007677 UB-04 · 2026-10-10 | Joseph Porter UHC-81468-86 | 2026-09-02 Outpatient hospital | Sunrise Diagnostic Imaging Radiology · in network | 70553 | $2,918.00 | — | Left for review REPL CO50 | — | Needs review |
| CLM-2026-007662 UB-04 · 2026-10-10 | Tyler Lawson UHC-01679-18 | 2026-08-30 Outpatient hospital | Northgate Medical Group Family Medicine · in network | 70553 | $1,980.00 | — | Left for review CO50 | — | 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.