GoHealthcare Practice Solutions
3805 Route 9 South, Freehold, NJ 07728
Management Services Organization · Activity Feed
Live activity across 4 referring practices · 4 active prior-auth cases
Approval Rate
50%
Cases Under Review
3
EOD MSO Approval
0/1
Revenue Protected
$59K
AI Logic Efficiency
-56hrs
Total time saved this cycle · 14h/packet × 4
Legend
AI Score
Predicted probability of payor approval based on clinical documentation completeness, payor policy match, prior-auth history, and medical-necessity strength.
Active Clinical Pipeline
| Patient / Case ID | Practice | Procedure | Doctor | Insurance | Status | Submitted | AI Score | Action |
|---|---|---|---|---|---|---|---|---|
| Hudson Spine Institute Referring practice | Lumbar Fusion (L4-L5) | Dr. Marcus Wei, MD | United Healthcare PPO | Missing Docs | Jun 1, 2026 | 42 | ||
| Atlantic Orthopedic Associates Referring practice | Total Knee Arthroplasty | Dr. Lisa Park, MD | Blue Cross Blue Shield PPO | Clinical Review | May 28, 2026 | 85 | ||
| Garden State Sports Medicine Referring practice | ACL Reconstruction | Dr. Marcus Wei, MD | Cigna PPO | Pending Review | May 25, 2026 | 71 | ||
| Shore Joint Replacement Center Referring practice | Rotator Cuff Repair | Dr. Lisa Park, MD | Aetna PPO | Ready for Submission | May 20, 2026 | 92 |
ROM Nexus™ Clinical Justification
Patient
Miller, Sarah
DOB 1962-03-14 · MRN-44218
Case #
ROM-8821
AI Score 85
Procedure
Total Knee Arthroplasty
CPT 27447
Payor
Blue Cross Blue Shield PPO
Member BCBS-887412901
Procedure Rules: Total Knee Arthroplasty
- ✓Imaging on file — MRI 2026-05-12
- ✓12 weeks of PT (completed 2026-04)
- ✓NSAIDs + corticosteroid injections × 2
- ✓Weight management program
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 for Total Knee Arthroplasty.