WorklistAUTH-2024-0892

James Whitfield

Pending

Lumbar Spinal Fusion — 22633

MRN-331009 · DOB 1978-07-22 · Aetna · AET-7712883-01

$42,000

Estimated case value

Agent Activity Timeline

6 events
  1. Case Received & Intake CompleteSystem

    Nov 1, 8:14 AM

    Prior auth request received from Regional Spine Institute. Patient demographics, diagnosis codes, and procedure codes verified against member eligibility.

  2. Clinical Documents ExtractedAI Agent

    Nov 1, 8:17 AM

    Agent extracted 4 supporting documents: MRI report (10/14/2024), office notes x2, failed conservative therapy documentation. All documents indexed and attached.

  3. Aetna Portal SubmissionAI Agent

    Nov 1, 9:02 AM

    Auth request submitted via Aetna's NaviNet portal. Reference #AET-REF-20241101-88234 assigned. Estimated review window: 3–5 business days.

  4. Peer-to-Peer ScheduledPayer

    Nov 3, 2:30 PM

    Aetna medical reviewer requested additional clinical clarification. Peer-to-peer review scheduled for 11/05 at 2:00 PM with Dr. Robert Patel.

  5. Additional Documentation SubmittedAI Agent

    Nov 4, 10:00 AM

    Per payer request, submitted updated functional assessment scores (Oswestry Disability Index = 58%) and employer disability letter.

  6. Peer-to-Peer Review CompletedHuman

    Nov 5, 2:05 PM

    Dr. Patel completed peer-to-peer with Aetna medical director Dr. Holloway. Decision pending — expected within 24 hours.

Clinical Documents

6 files

MRI_Lumbar_Spine_20241014.pdf

Imaging Report · 2.4 MB · Uploaded 2024-11-01

Office_Notes_08212024.pdf

Clinical Notes · 380 KB · Uploaded 2024-11-01

Office_Notes_09182024.pdf

Clinical Notes · 410 KB · Uploaded 2024-11-01

Conservative_Tx_Failure_Documentation.pdf

Treatment History · 215 KB · Uploaded 2024-11-01

Functional_Assessment_Oswestry.pdf

Functional Assessment · 190 KB · Uploaded 2024-11-04

Employer_Disability_Letter.pdf

Supporting Letter · 125 KB · Uploaded 2024-11-04

Case Information

Case ID
AUTH-2024-0892
Provider
Dr. Robert Patel
Facility
Regional Spine Institute
Diagnosis
M51.16
Procedure Code
22633
Submitted
2024-11-01
Last Updated
2024-11-05

Clinical Notes

Patient has documented conservative treatment failure x 6 months. MRI confirms L4-L5 herniation with nerve compression. All pre-auth requirements submitted.

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