Surgical Qualification

Active Case Flow & Revenue Integrity Pipeline

Approval Rate

94.2%

+2.4%vs last month

Cases Under Review

42

12 Urgentrequires action

Revenue Protected

$1.42M

8 Denials Avoided

AI Logic Efficiency

-14hrs

Avg. time saved per packet

Active Clinical Pipeline

Patient / Case IDProcedureStatusAI ScoreAction
Miller, Sarah
#ROM-8821
Total Knee ArthroplastyClinical Review
85
Henderson, James
#ROM-9012
Lumbar Fusion (L4-L5)Missing Docs
42
Alvarez, Maria
#ROM-9104
Rotator Cuff RepairReady for Submission
92
Park, Daniel
#ROM-9211
ACL ReconstructionPending Review
71

ROM Nexus AI™ Clinical Justification

Live Parsing

Procedure Rules: TKA

  • ✓
    Severe Osteoarthritis Confirmed (X-Ray)
  • ✓
    Failure of Conservative Tx (>6mo)
  • ?
    Missing Functional Limitation Evidence
AI-overlay bone density scan of a human knee joint

High Denial Risk

The physician narrative lacks specific pain scale duration for the last 30 days. Recommend adding patient-reported outcome measures (PROMs).

Revenue Integrity Check

CPT 27447 validation complete. Medical necessity documentation supports current coding selection.