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-2026-022851 UB-04 · 2026-10-18 | Pamela Tran UHC-95837-67 | 2026-04-02 Outpatient hospital | Cornerstone Orthopedic Specialists Orthopedic Surgery · out of network | 29881 | $8,489.00 | — | Denied by rule CO29 | — | Denied |
| CLM-2026-013424 UB-04 · 2026-10-18 | Jordan Thomas UHC-00688-86 | 2026-04-19 Emergency room | Mesa Regional Medical Center Emergency Medicine · out of network | 71046, 99285 | $2,289.00 | — | Denied by rule CO29 | — | Denied |
| CLM-2026-002809 UB-04 · 2026-10-18 | Olivia Armstrong UHC-25797-48 | 2026-05-27 Outpatient hospital | Sunrise Cardiovascular Associates Cardiology · in network | 93458, 93015 | $5,527.00 | — | Denied by rule CO29 | — | Denied |
| CLM-2026-007944 UB-04 · 2026-10-15 | Ryan Walker UHC-79552-94 | 2026-05-28 Emergency room | Valley Community Hospital Emergency Medicine · out of network | 99283, 71046 | $1,287.00 | — | Denied by rule CO29 | — | Denied |
| CLM-2026-034029 UB-04 · 2026-10-14 | Ryan Li UHC-59343-89 | 2026-06-24 Outpatient hospital | Mesa GI Associates Gastroenterology · in network | 88305 | $352.00 | — | Denied by rule CO29 | — | Denied |
| CLM-2026-023532 UB-04 · 2026-10-14 | Andrew Hicks UHC-20492-19 | 2026-03-30 Outpatient hospital | Pinecrest Diagnostic Imaging Radiology · in network | 70553, 71046 | $2,750.00 | — | Denied by rule CO29 | — | Denied |
| CLM-2026-009820 UB-04 · 2026-10-09 | Walter Weber UHC-22039-25 | 2026-03-31 Outpatient hospital | Cornerstone Bone and Joint Center Orthopedic Surgery · in network | 29881 | $10,142.00 | — | Denied by rule CO29 | — | Denied |
| CLM-2026-030444 UB-04 · 2026-10-08 | Kenneth Hughes no member ID | 2026-05-06 Emergency room | Summit Regional Medical Center Emergency Medicine · in network | 96374, 99285 | $2,613.00 | — | Denied by rule CO29 | — | Denied |
| CLM-2026-031027 UB-04 · 2026-09-30 | Alan Lee no member ID | 2026-02-25 Emergency room | Summit Regional Medical Center Emergency Medicine · in network | 99283, 96374 | $956.00 | — | Denied by rule CO29 | — | Denied |
| CLM-2026-012976 UB-04 · 2026-09-28 | Samuel Ray UHC-71219-67 | 2026-03-21 Outpatient hospital | Mesa GI Associates Gastroenterology · in network | 45378, 43239 | $4,467.00 | — | Denied by rule CO29 | — | Denied |
| CLM-2026-000715 UB-04 · 2026-09-28 | Bruce Porter UHC-38921-20 | 2026-02-20 Outpatient hospital | Meadow Heart Institute Cardiology · out of network | 93306 | $902.00 | — | Denied by rule CO29 CO204 | — | Denied |
| CLM-2026-033531 UB-04 · 2026-09-21 | Carol Henry UHC-64577-07 | 2026-05-27 Outpatient hospital | Evergreen Diagnostic Imaging Radiology · in network | 77067, 74177, 71046 | $3,177.00 | — | Denied by rule CO29 | — | Denied |
| CLM-2026-026244 UB-04 · 2026-09-20 | Jackie Diaz UHC-15009-91 | 2026-03-11 Outpatient hospital | Desert Heart Institute Cardiology · in network | 93458 | $5,581.00 | — | Denied by rule CO29 | — | Denied |
| CLM-2026-000583 UB-04 · 2026-09-20 | Bruce Martinez UHC-23802-99 | 2026-02-23 Outpatient hospital | Cornerstone Digestive Health Center Gastroenterology · in network | 43239, 88305 | $2,709.00 | — | Denied by rule CO29 | — | Denied |
| CLM-2026-034583 UB-04 · 2026-09-17 | Donald Mejia UHC-18967-39 | 2026-02-24 Emergency room | Riverside Regional Medical Center Emergency Medicine · out of network | 71046, 99285 | $2,180.00 | — | Denied by rule CO29 | — | Denied |
| CLM-2026-003184 UB-04 · 2026-09-17 | Scott Gibson UHC-52419-70 | 2026-06-14 Emergency room | Unity Community Hospital Emergency Medicine · in network | 99284 | $1,493.00 | — | Denied by rule CO29 | — | Denied |
| CLM-2026-032496 UB-04 · 2026-09-16 | Sofia Ramirez UHC-92206-23 | 2026-03-02 Outpatient hospital | Unity Diagnostic Imaging Radiology · in network | 77067, 74177 | $2,034.00 | — | Denied by rule CO29 | — | Denied |
| CLM-2026-027577 UB-04 · 2026-09-15 | Angela Johnston UHC-84082-76 | 2026-04-07 Inpatient hospital | Cornerstone Orthopedic Specialists Orthopedic Surgery · out of network | 27447 | $48,024.00 | — | Denied by rule CO29 | — | Denied |
| CLM-2026-032553 UB-04 · 2026-09-13 | Kelly Herrera UHC-57765-55 | 2026-06-06 Emergency room | Heritage Community Hospital Emergency Medicine · in network | 71046 | $136.00 | — | Denied by rule CO29 | — | Denied |
| CLM-2026-021722 UB-04 · 2026-09-11 | Donad Ruiz UHC-28641-21 | 2026-02-05 Outpatient hospital | Evergreen Diagnostic Imaging Radiology · in network | 76700, 77067, 70553 | $4,251.00 | — | Denied by rule CO29 | — | Denied |
| CLM-2026-020448 UB-04 · 2026-09-10 | Amanda Fox UHC-00623-39 | 2026-05-04 Outpatient hospital | Riverside Bone and Joint Center Orthopedic Surgery · out of network | 73721, 29881 | $8,998.00 | — | Denied by rule CO29 | — | Denied |
| CLM-2026-008685 UB-04 · 2026-09-10 | Randy Sims UHC-91736-60 | 2026-02-25 Outpatient hospital | Sunrise Cardiovascular Associates Cardiology · in network | 93458 | $5,465.00 | — | Denied by rule CO29 | — | Denied |
| CLM-2026-003187 UB-04 · 2026-09-08 | Emily Thompson UHC-60492-22 | 2026-04-25 Outpatient hospital | Riverside GI Associates Gastroenterology · in network | 88305 | $317.00 | — | Denied by rule CO29 | — | Denied |
| CLM-2026-018945 UB-04 · 2026-09-06 | Megan Maqruez UHC-86538-02 | 2026-03-24 Outpatient hospital | Heritage Orthopedic Specialists Orthopedic Surgery · in network | 73721, 29881 | $8,361.00 | — | Denied by rule CO29 | — | Denied |
| CLM-2026-018327 UB-04 · 2026-09-05 | Betty Scott UHC-50628-36 | 2026-02-23 Outpatient hospital | Evergreen Diagnostic Imaging Radiology · in network | 74177, 76700, 77067 | $2,298.00 | — | Denied by rule CO29 | — | Denied |
| CLM-2026-029932 UB-04 · 2026-09-01 | Mateo Obrien UHC-64674-51 | 2026-04-25 Outpatient hospital | Riverside Imaging Center Radiology · in network | 76700, 71046, 74177 | $2,240.00 | — | Denied by rule CO29 | — | Denied |
| CLM-2026-003892 UB-04 · 2026-09-01 | Nick Walsh no member ID | 2026-05-07 Outpatient hospital | Sunrise Diagnostic Imaging Radiology · in network | 74177, 70553 | $4,988.00 | — | Denied by rule CO29 | — | Denied |
| CLM-2026-003159 UB-04 · 2026-08-31 | Austin Cunningham UHC-71262-56 | 2026-02-16 Emergency room | Riverside Community Hospital Emergency Medicine · in network | 96374, 99283, 71046 | $1,444.00 | — | Denied by rule CO29 | — | Denied |
| CLM-2026-034036 UB-04 · 2026-08-29 | Andrea Whhite UHC-79988-26 | 2026-04-22 Inpatient hospital | Harbor Medical Group Internal Medicine · out of network | 99232 | $219.00 | — | Denied by rule CO29 CO204 | — | Denied |
| CLM-2026-010472 UB-04 · 2026-08-29 | Grace Mdeina UHC-02912-01 | 2026-03-29 Outpatient hospital | Northgate Bone and Joint Center Orthopedic Surgery · out of network | 29881 | $8,795.00 | — | Denied by rule CO29 | — | Denied |
| CLM-2026-019128 UB-04 · 2026-08-28 | Grace Burton UHC-52024-75 | 2026-02-11 Emergency room | Unity Community Hospital Emergency Medicine · in network | 99285 | $2,544.00 | — | Denied by rule CO29 | — | Denied |
| CLM-2026-009386 UB-04 · 2026-08-26 | Alexis Diaz no member ID | 2026-04-22 Emergency room | Meadow Regional Medical Center Emergency Medicine · in network | 71046 | $224.00 | — | Denied by rule CO29 | — | Denied |
| CLM-2026-008262 UB-04 · 2026-08-26 | Samantha Graham UHC-69287-28 | 2026-04-15 Outpatient hospital | Evergreen Cardiovascular Associates Cardiology · in network | 93015 | $485.00 | — | Denied by rule CO29 | — | Denied |
| CLM-2026-022954 UB-04 · 2026-08-25 | Linda Obrien UHC-52970-96 | 2026-05-06 Outpatient hospital | Canyon GI Associates Gastroenterology · in network | 45378, 43239 | $5,211.00 | — | Denied by rule CO29 | — | Denied |
| CLM-2026-020054 UB-04 · 2026-08-25 | Willie Vega UHC-62858-70 | 2026-02-05 Emergency room | Heritage Community Hospital Emergency Medicine · in network | 99285 | $2,809.00 | — | Denied by rule CO29 | — | Denied |
| CLM-2026-021071 UB-04 · 2026-08-19 | Elizabeth Nelson UHC-53683-17 | 2026-04-29 Outpatient hospital | Desert Diagnostic Imaging Radiology · in network | 77067 | $340.00 | — | Denied by rule CO29 | — | Denied |
| CLM-2026-018857 UB-04 · 2026-08-19 | Linda Munoz UHC-59937-01 | 2026-05-12 Outpatient hospital | Valley Bone and Joint Center Orthopedic Surgery · out of network | 73721 | $1,335.00 | — | Denied by rule CO29 | — | Denied |
| CLM-2026-022480 UB-04 · 2026-08-18 | Lauren Franklin UHC-18434-28 | 2026-02-08 Outpatient hospital | Summit Imaging Center Radiology · in network | 76700 | $449.00 | — | Denied by rule CO29 | — | Denied |
| CLM-2026-001233 UB-04 · 2026-08-15 | Olivia Hunt UHC-22928-25 | 2026-05-08 Outpatient hospital | Mesa Cardiovascular Associates Cardiology · in network | 93015, 93306 | $1,912.00 | — | Denied by rule CO29 | — | Denied |
| CLM-2026-013092 UB-04 · 2026-08-13 | Nicholas Adams UHC-35449-26 | 2026-01-24 Outpatient hospital | Northgate Cardiovascular Associates Cardiology · in network | 93458, 93306 | $8,923.00 | — | Denied by rule CO29 | — | Denied |
| CLM-2026-032230 UB-04 · 2026-08-04 | David Larson UHC-94457-68 | 2026-04-07 Outpatient hospital | Canyon Cardiovascular Associates Cardiology · in network | 93458 | $7,180.00 | — | Denied by rule CO29 | — | Denied |
| CLM-2026-032671 UB-04 · 2026-08-03 | Stephen King UHC-15796-58 | 2026-03-13 Outpatient hospital | Desert Cardiovascular Associates Cardiology · in network | 93306 | $1,374.00 | — | Denied by rule CO29 | — | Denied |
| CLM-2026-023664 UB-04 · 2026-08-03 | Sofia Wilson UHC-06608-41 | 2026-02-17 Outpatient hospital | Pinecrest GI Associates Gastroenterology · in network | 88305, 43239 | $2,585.00 | — | Denied by rule CO29 | — | Denied |
| CLM-2026-018578 UB-04 · 2026-08-02 | Keith Rojas UHC-26687-74 | 2026-04-11 Inpatient hospital | Heritage Orthopedic Specialists Orthopedic Surgery · in network | 27447 | $49,532.00 | — | Denied by rule CO29 | — | Denied |
| CLM-2026-032054 UB-04 · 2026-07-30 | Arjun Elliott UHC-67426-37 | 2026-01-11 Outpatient hospital | Meadow Imaging Center Radiology · in network | 70553, 74177 | $4,653.00 | — | Denied by rule CO29 | — | Denied |
| CLM-2026-016386 UB-04 · 2026-07-30 | Matthew Ferguson UHC-66125-48 | 2026-01-11 Emergency room | Meadow Regional Medical Center Emergency Medicine · in network | 99283, 71046 | $1,207.00 | — | Denied by rule CO29 | — | Denied |
| CLM-2026-029939 UB-04 · 2026-07-26 | Mason Palmer UHC-10433-05 | 2026-01-03 Outpatient hospital | Mesa Orthopedic Specialists Orthopedic Surgery · in network | 73721, 29881 | $8,380.00 | — | Denied by rule CO29 | — | Denied |
| CLM-2026-022975 UB-04 · 2026-07-25 | Frances Hayes UHC-79363-79 | 2025-12-24 Emergency room | Pinecrest Regional Medical Center Emergency Medicine · in network | 71046 | $198.00 | — | Denied by rule CO29 | — | Denied |
| CLM-2026-009885 UB-04 · 2026-07-25 | Carl Montgomery UHC-57349-54 | 2026-02-22 Outpatient hospital | Sunrise Imaging Center Radiology · in network | 76700, 71046, 77067 | $1,014.00 | — | Denied by rule CO29 | — | Denied |
| CLM-2026-003306 UB-04 · 2026-07-25 | Steven Carr UHC-95393-63 | 2026-03-12 Outpatient hospital | Harbor Bone and Joint Center Orthopedic Surgery · in network | 73721 | $2,025.00 | — | Denied by rule CO29 | — | 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.