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Authorization queue

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Showing 5 of 5 items

PA-1048

Not submittedPriority · Standard

Created Apr 24, 2024 · Last updated 2 hours ago

Alex MorganSynthetic patient · Case PA-1048

Authorization details

Payer
Meridian Health Plan
Requested service
MRI Lumbar Spine (w/o contrast)
Diagnosis (ICD-10)
M54.5 – Low back pain, unspecified
Ordering provider
Dr. Jamie Diaz
Servicing facility
Not selected
Assigned coordinator
Erin Wallace
Due date
Apr 28, 2024

Action required before submissionThis authorization is missing required document(s). Review the checklist and upload the items below to enable submission.

Requirements checklist

  • Clinical noteMost recent office visit note (within 90 days)UploadedApr 24, 2024
  • Patient insurance eligibilityVerify active coverage and benefitsCompletedApr 24, 2024
  • !Payer prior authorization formMeridian standard PA form (required)MissingRequest document
  • ?Additional clinical informationImaging reports, conservative treatment, etc. (if applicable)Optional

Documents (2)

  • Clinical Note – 04/24/2024.pdfv1 Apr 24, 2024 · 428 KB
  • Insurance Eligibility – Meridian.pdfv1 Apr 24, 2024 · 216 KB
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Activity

  1. Case createdApr 24, 2024 9:12 AMErin Wallace
  2. Clinical note uploadedApr 24, 2024 10:03 AMErin Wallace
  3. Eligibility verifiedApr 24, 2024 10:05 AMErin Wallace
  4. Missing document identifiedApr 24, 2024 10:06 AMSystem
  5. Reminder sent to patientApr 24, 2024 10:07 AMErin Wallace

Next action

Request missing document

Contact patient to obtain the Meridian PA form.

Owner Erin Wallace · Apr 28, 2024

Upload all required documents to enable submission. Nothing is sent to a payer from this design concept.