Happy-path MRI knee referral

Score

96.0

Pass · 1m 38s

Criteria

Patient / CPT / ICD / NPI match ground truth1.0

Correctly routed as in-scope (no return)1.0

ORM^O01 structurally valid1.0

FHIR Coverage queried before export1.0

Patient

Marcus Bell, 35M

MRN

MRN-MC-00102

Referrer

Dr. Alan Reeves (NPI 1558201496)

Payer

Anthem Blue Cross of California

Procedure

CPT 73721 — MRI right knee w/o contrast

Primary Dx

M23.91 — Internal derangement, right knee

Decision

In-scope → HL7 ORM^O01 emitted

Changes made by agent

SFTP Inboxreferral-01-mri-knee.pdf (unread)→Processed · removed from /inbound

HL7 Interface—→ORM^O01 accepted (MSG-4501)

FHIR ServiceRequest—→Draft posted for MRN-MC-00102

Agent Activity

0:00

Fetched PDF from SFTP inbox

Listed /inbound, downloaded referral-01-mri-knee.pdf (3 pages), hashed for duplicate check.

0:12

OCR + structured extraction

Extracted patient demographics, CPT 73721, ICD M23.91, NPI 1558201496, and electronic provider signature.

0:31

FHIR patient + coverage match

Matched MRN-MC-00102 (Marcus Bell) by DOB + name; verified active Anthem coverage via Coverage resource.

0:52

Applied medical necessity policy

CPT 73721 with ICD M23.91 matches accepted imaging policy for OA/internal-derangement knee pain.

1:18

Emitted HL7 ORM^O01

Built ORM^O01 with PID/ORC/OBR segments, sent to HL7 interface, received AA (accepted) ACK.

1:41

Marked fax processed

Moved inbound PDF to /archive and wrote audit record.