CLM-2025-001852
Lakewood Family Medicine Group · Medicaid · 837P
⌘K
AI Correction Recommendation
Medicaid allows Q0091 once every 36 months per beneficiary. Last claim for PT-72081 was filed 28 months ago. Patient is not yet eligible. Consider patient billing or write-off.
AI Confidence: High
CLM-2025-001852
DeniedLakewood Family Medicine Group · Medicaid
$310.00
0Provider
Dr. Emily Hartman
Patient Ref
PT-72081
Service Date
2025-01-09
Claim Type
837P
Billing Summary
Diagnosis Codes
Z12.31Z00.00
Procedure Codes
G0101Q0091
Denial / Rejection Analysis
PR-96: Non-covered charges — Frequency limit exceeded
Source: Payer adjudication response via Claim.MD 999 acknowledgement
Route: MASE → Claim.MD adapter → Medicaid EDI
Claim Timeline
Claim created and imported10:01 AM
Received via batch upload
MASE Rules Engine — Scrub initiated10:01 AM
8 rules evaluated
MASE AI Scrub completed10:02 AM
Passed all validation checks
Routed to Claim.MD adapter10:03 AM
claimmd-claims-adapter v2.1
Submitted to payer via Claim.MD10:04 AM
ISA batch 00421 · GS group 004
999 Acknowledgement received10:05 AM
AK2 accepted — Functional Group OK
MASE AI Scrub
Risk Score91 / 100
Scrub ResultPassed
Rules Evaluated8 / 8
AI Modelmase-scrub-v3.1
Claim.MD Transaction Trace
Routing StatusAcknowledged
Ack ResultAccepted
Adapterclaimmd-claims-adapter
ISA Batch00421
Correction Checklist
Recommended Next Action
Apply AI-suggested correction, update claim data, and resubmit via MASE correction workflow.