EOB — Medicare Advantage. Plan: Health First MA. Member: MEM-72601. Date of Service: 2026-04-05. Provider: Brevard Cardiology Associates (NPI 0000000003). Service: Cardiology follow-up + EKG (CPT 99214 + 93000). Billed: $385. Allowed: $0. Paid: $0. CARC 22 — This care may be covered by another payer per coordination of benefits. Member is a VA-eligible veteran. Service relates to a service-connected ischemic heart condition. VA has issued community-care authorization # CC-2026-3982 for this provider.
No appeal of the MA denial is appropriate. VA community-care authorizations make VA the primary payer for the authorized service. Direct the provider to bill VA Community Care directly using the authorization number CC-2026-3982. The MA plan does not coordinate or cover VA-authorized services for service-connected conditions. Member should not be balance-billed; if the provider attempts to bill the member, refer the member to the VA Community Care office.
VA community-care authorizations override MA secondary-payer rules — the VA pays primary, the MA does not coordinate. Appealing the MA denial would not produce coverage; the right action is redirecting billing to VA. Right triage: refuse to appeal.
Per-scenario model output is captured during a leaderboard Run all. Trigger a run from the leaderboard to see each variant’s output side-by-side with the ground truth here.
To run this scenario through the live cockpit, copy the EOB above into the cockpit and watch the streamed triage in context.