Total Knee Replacement — United Healthcare
Score
Criteria
Missed documenting patient's previous corticosteroid injection from 3 months prior.
Patient
Patient
Maria Garcia, 67F
Primary Dx
M17.11 — OA right knee
Payer
United Healthcare PPO
Procedure
CPT 27447 — TKR
PT History
8 months (completed)
BMI
28.4
Changes made by agent
Agent Activity
0:00
Read patient chart
Accessed Patient resource, Condition, MedicationRequest. Found primary diagnosis M17.11 (primary osteoarthritis, right knee).
0:12
Checked payer requirements
Queried United Healthcare portal for CPT 27447 prior auth rules. Requirements: conservative treatment ≥6 months, imaging, BMI documentation.
0:31
Gathered supporting evidence
Found 8 months of physical therapy notes, recent X-ray report, BMI 28.4 from latest vitals. All payer requirements met.
1:15
Composed clinical summary
Generated prior auth request with clinical justification, attached supporting documentation.
1:47
Submitted to payer portal
Submitted prior auth request via United Healthcare portal with clinical summary and 4 supporting attachments.
2:34
Authorization received
Auth #UHC-2026-4492817 received. Valid 90 days. Updated patient record with authorization reference.