Daily Review Case · 2026-09-13
Elm Handoff Boundary UM
Curtis Haugen is 73, covered under Calloway Preferred PPO through a retiree group. M. Serrano, MD ordered cardiac rehabilitation, monitored - 9 sessions over 07/29/2026 to 08/18/2026 - for chronic diastolic heart failure (I50.32). It reached the Elmbridge Health Partners utilization management desk on 07/19/2026 for service continuation review. Reading it through, the decision needs a fact only another team or the physician reviewer can supply. The decision is due 07/26/2026, 7 days from the day the plan logged it in. Your job is to gather and verify what the request needs and route it to the clinical reviewer. The medical-necessity call is theirs to make, not yours.
Review the synthetic packet, take the available workflow actions, and write a concise professional note before submission.
- Track
- Utilization Management
- Difficulty
- Hard
- Time
- 18 minutes