Modeled on a utilization management escalation workflow
- Track
- Utilization Management
- Difficulty
- Hard
- Time
- 20 minutes
Deja Threadgill is 66 and covered under Meridian Advantage HMO. T. Okonkwo, MD ordered negative pressure wound therapy - 14 weeks over 04/26/2026 to 08/01/2026 - for non-pressure chronic ulcer of lower leg (L97.909). It reached your utilization management desk on 04/17/2026. Reading it through, the critical labs is named in the record but is not in the packet. The decision is due 04/24/2026, 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.