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University Heart Center

Cardiovascular Hospital

Facility

100 University Way, Denver, CO 80204

(303) 555-9999

Enhanced Provider Data
Inpatient Hospital
Service Date
Nov 14, 2025
to Nov 19, 2025
Claim ID
EOB-2024-002001
Provider NPI
Not Available
Status
Approved

Financial Breakdown

Coverage Details

Covered Service
Part A
No Deductible Required

This service is covered under your insurance plan. No deductible was applied to this claim.

Cost Breakdown

Provider Charged:$75,000.00
Medicare Allowed:$42,000.00
Medicare Paid:$42,000.00
Your Responsibility:$0.00

Coverage Insights

100% Medicare Coverage: Certain services on this claim are covered at 100% by Medicare with no patient responsibility.
Processing Details:
  • Inpatient hospital stay covered under Part A benefit
  • Part A deductible previously met for this benefit period

💡 These insights are derived from Medicare's adjudication data to help explain your coverage details.

AI Summary

Inpatient cardiac valve replacement surgery. 100% covered by Part A benefit after deductible (which was previously met).

AI analysis is for informational purposes only and should not replace professional medical or financial advice.

Risk Flags

Overcharges
No issues detected
Billing Errors
No issues detected
Fraud Indicators
No issues detected
Duplicate Services
No issues detected
Appeal Opportunities
No issues detected
Non Covered Services
No issues detected

Insights

Claim Complexity
high
Coverage Gaps Identified
Billing Accuracy Assessment
accurate
Potential Savings Opportunities

Tags

high-costinpatient
I35.0(ICD_10)AI Enhanced
Primary

Nonrheumatic aortic (valve) stenosis

Narrowing of the aortic valve opening in the heart. This restricts blood flow from the left ventricle to the aorta and may also affect the pressure in the left atrium.

Specialty
Cardiology
Category
Cardiovascular
Clinical Notes
Severe condition requiring surgical intervention (valve replacement) as indicated by the procedure codes.
Typical follow-up Care
Cardiac rehabilitation
Regular cardiologist visits
Anticoagulation therapy if mechanical valve

Present on admission: No

33405(CPT)AI Enhanced

Replacement of aortic valve

$22,000.00
Medicare Paid

Replacement of aortic valve

Surgical replacement of the aortic valve with a prosthetic valve other than a homograft or stentless valve. This is open heart surgery.

Specialty
Cardiothoracic Surgery
Category
Surgery
Service: Nov 14, 2025
Provider charged
$45,000.00
Medicare Allowed
$22,000.00
Medicare Paid
$22,000.00
Your responsibility
$0.00
0360(REVENUE)AI Enhanced

Operating Room Services

$15,000.00
Medicare Paid

Operating Room Services

General classification for operating room services provided by the hospital.

Specialty
Hospital
Category
Facility
Service: Nov 14, 2025
Provider charged
$25,000.00
Medicare Allowed
$15,000.00
Medicare Paid
$15,000.00
Your responsibility
$0.00
0370(REVENUE)AI Enhanced

Anesthesia

$5,000.00
Medicare Paid

Anesthesia

General classification for anesthesia services provided by the hospital (drugs and supplies).

Specialty
Anesthesiology
Category
Anesthesia
Service: Nov 14, 2025
Provider charged
$5,000.00
Medicare Allowed
$5,000.00
Medicare Paid
$5,000.00
Your responsibility
$0.00

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