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Different care. A shared challenge.

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Insurance work looks different in every specialty. Explore a common frustration, a sample request and how the team can prepare a more focused physician review.

44

specialties to explore

Staff prepares the case.
Physicians review the care.

Choose the work you know

The right next step,
for your care team.

These are fictional examples of intended administrative use, not tested specialty outcomes or payer coverage promises. Society guidelines, primary clinical resources and specific CMS documentation provide context for each example. Links do not imply endorsement or establish coverage. Medicare sources are contractor-, jurisdiction- and indication-specific.

44 specialties

Open a sample case to see the staff and physician roles.

Medical specialties

Allergy & immunology

Repeated requests for controller history, testing and exacerbation records delay a biologic review.

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Fictional workflow example

Allergic asthma biologic

Care requested
An allergist has prescribed omalizumab for a patient with asthma.
What needs attention
Relevant testing and recent exacerbation records are in different chart sections.

Staff prepares

  • Bring testing, controller use and documented exacerbations together.
  • Flag missing or conflicting details before staff submits for review.

Physician reviews

  • Confirm the asthma history and patient-specific treatment rationale.

Only existing evidence supports the draft; dosing and therapy decisions remain clinical.

Sources for context

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Surgical specialties

Anesthesiology

A medical-necessity denial overlooks patient-specific reasons for anesthesia care.

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Fictional workflow example

Anesthesia claim reconsideration

Care requested
An anesthesia claim for a GI procedure is denied for missing risk information.
What needs attention
Relevant pre-anesthesia findings were not included in the claim review.

Staff prepares

  • Link the denial to the existing pre-anesthesia assessment and procedure record.
  • Prepare a focused draft for review rather than sending the entire chart.

Physician reviews

  • Confirm the documented risks and reason for the anesthesia service.

Clinical necessity, coding and the applicable benefit are reviewed separately.

Sources for context

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Medical specialties

Cardiology

Imaging review stalls because the symptoms, prior tests and requested study do not appear together.

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Fictional workflow example

Coronary CT angiography

Care requested
A cardiologist orders coronary CT angiography after evaluating chest symptoms.
What needs attention
A prior test report is referenced but has not been attached.

Staff prepares

  • Match the order to symptoms and available prior test reports.
  • Flag the missing report and prepare a source-linked explanation for review.

Physician reviews

  • Confirm why this study is needed for this patient.

Asclepius does not calculate coverage eligibility or choose the cardiac test.

Sources for context

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Surgical specialties

Colon & rectal surgery

A denied surveillance study is missing the earlier pathology that explains why it was ordered.

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Fictional workflow example

Surveillance colonoscopy review

Care requested
A colorectal clinician requests review of a denied colonoscopy.
What needs attention
The earlier polyp pathology and prior procedure date are not attached.

Staff prepares

  • Build a dated record of prior procedures and available pathology.
  • Draft a response tied to the stated denial reason.

Physician reviews

  • Verify the indication and relevant history.

Staff must verify the correct screening, surveillance or diagnostic classification.

Sources for context

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Medical specialties

Dermatology

A request for systemic therapy lacks the severity and prior-treatment story the reviewer needs.

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Fictional workflow example

Plaque psoriasis authorization

Care requested
A dermatologist requests a biologic for plaque psoriasis.
What needs attention
The request omits the documented extent of disease and prior therapy response.

Staff prepares

  • Organize examination findings and the treatment timeline.
  • Ask staff for missing evidence before final packet review.

Physician reviews

  • Confirm disease burden and the reason for escalation.

These are illustrative documentation needs, not a universal approval rule.

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Imaging, genetics & laboratory

Diagnostic & interventional radiology

A study is delayed because the referral lacks the clinical history already known to the ordering team.

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Fictional workflow example

MRI request with incomplete referral

Care requested
An imaging center receives a lumbar MRI order.
What needs attention
The supplied history does not include the ordering clinician’s examination.

Staff prepares

  • Match the order to available referring notes and prior studies.
  • Route missing-history questions to staff and preserve the ordering clinician’s review.

Physician reviews

  • Verify the patient-specific reason for the ordered study.

Radiology and the ordering practice retain their distinct clinical responsibilities.

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Acute, rehabilitation & continuing care

Emergency medicine

A retrospective denial reduces a complex emergency visit to its final diagnosis.

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Fictional workflow example

Emergency claim denial review

Care requested
A payer questions the necessity of an emergency visit.
What needs attention
The original submission does not include the presenting symptoms and assessment.

Staff prepares

  • Organize the actual presentation, clinician assessment and denial notice.
  • Prepare a source-linked response for authorized staff review.

Physician reviews

  • Verify the presentation summary and relevant clinical facts.

Emergency care must not wait for this workflow. This example is retrospective review, not prior approval.

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Medical specialties

Endocrinology

Staff must repeatedly find insulin history and glucose information for a device request or renewal.

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Fictional workflow example

Continuous glucose monitor renewal

Care requested
A patient is due for a renewal of a prescribed continuous glucose monitor.
What needs attention
The latest follow-up and response to the device are missing from the request.

Staff prepares

  • Bring together the device order, regimen and follow-up record.
  • Flag missing renewal evidence and route the reviewed packet to staff.

Physician reviews

  • Check the short treatment summary and ongoing clinical need.

Renewal criteria are plan-specific; missing information remains unresolved until verified.

Sources for context

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Medical specialties

Family medicine & primary care

A request comes back asking for treatment dates that are buried in several visit notes.

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Fictional workflow example

Lumbar MRI after ongoing symptoms

Care requested
A clinician has ordered a lumbar MRI for persistent radiating pain.
What needs attention
The referral describes prior treatment but omits its dates and results.

Staff prepares

  • Bring the visit notes, referral and documented treatment course into one review.
  • Flag missing dates before staff prepares the request.

Physician reviews

  • Confirm the symptom summary and the clinical reason for the ordered study.

The clinician decides whether imaging is appropriate; a coverage checklist does not replace that decision.

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Medical specialties

Gastroenterology & hepatology

A biologic request is returned because earlier medication trials are scattered across records.

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Fictional workflow example

Crohn disease biologic request

Care requested
A gastroenterologist requests a prescribed biologic for Crohn disease.
What needs attention
The record lists earlier treatments without a clear response timeline.

Staff prepares

  • Build a dated treatment history from the available notes and medication records.
  • Flag unknown outcomes rather than inventing failed therapy.

Physician reviews

  • Confirm disease activity, prior responses and the reason for the requested therapy.

Drug choice and any exception argument require clinician review.

Sources for context

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Surgical specialties

General surgery

A bariatric request stalls while the practice chases records from several preoperative visits.

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Fictional workflow example

Bariatric surgery packet

Care requested
A surgeon has recommended a bariatric procedure after evaluation.
What needs attention
The packet lacks some program participation and assessment records.

Staff prepares

  • Organize existing evaluations and program records against the selected plan.
  • Assign only the missing-document tasks to staff.

Physician reviews

  • Confirm the clinical rationale and summary of completed evaluation.

Benefits and surgical candidacy must each be verified; a plan exclusion is not cured by more paperwork.

Sources for context

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Acute, rehabilitation & continuing care

Geriatric medicine

Equipment and therapy requests require information from several clinicians and care settings.

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Fictional workflow example

Rehabilitation after hospitalization

Care requested
A geriatric clinician supports prescribed therapy after discharge.
What needs attention
The outpatient request is missing the discharge and therapy assessments.

Staff prepares

  • Bring authorized discharge and functional records into one review.
  • Flag missing documents instead of asking the physician to reconstruct the whole stay.

Physician reviews

  • Confirm the concise functional summary and care goal.

Facility placement and coverage eligibility remain separate decisions.

Sources for context

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Medical specialties

Hematology & medical oncology

A staging study is delayed while staff gathers pathology and earlier imaging.

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Fictional workflow example

Oncology staging PET/CT

Care requested
An oncologist requests a PET/CT to inform the next treatment decision.
What needs attention
The pathology report is referenced but not attached.

Staff prepares

  • Link the diagnosis, pathology and available imaging to the order.
  • Flag the missing report and draft the stated purpose of the study.

Physician reviews

  • Confirm how the result would affect the documented plan.

Stage, biomarkers and expected results are never inferred from incomplete records.

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Acute, rehabilitation & continuing care

Hospice & palliative medicine

A documentation review takes time away from care when supporting records are scattered.

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Fictional workflow example

Hospice documentation review

Care requested
A hospice team prepares records for a coverage review.
What needs attention
The current certification is not linked to the supporting clinical history.

Staff prepares

  • Organize the available certification and relevant dated care records.
  • Flag missing documents and inconsistent dates for the responsible team.

Physician reviews

  • Review the actual clinical narrative and any required certification.

Only an authorized clinician makes and signs prognosis or certification judgments.

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Medical specialties

Infectious diseases

Home treatment is held up by missing order details or uncertainty about the approved care setting.

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Fictional workflow example

Outpatient IV antibiotic course

Care requested
An infectious disease physician has ordered a home antibiotic course.
What needs attention
The packet needs the signed plan and a confirmed delivery setting.

Staff prepares

  • Bring the order, available culture results and treatment dates together.
  • Flag missing plan details and record staff coordination with the infusion service.

Physician reviews

  • Verify the indication, course and monitoring summary.

The treating team selects the antibiotic and safe setting; benefits are verified separately.

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Medical specialties

Internal medicine

The clinical request is complete, but the medical and pharmacy benefit routes are unclear.

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Fictional workflow example

Diabetes device request

Care requested
An internist orders a glucose monitoring device for a patient using insulin.
What needs attention
The packet needs the current regimen and the correct benefit route.

Staff prepares

  • Organize the order, recent visit and diabetes treatment history.
  • Keep the plan response and any missing benefit information in the staff queue.

Physician reviews

  • Verify the current regimen and patient-specific reason for the device.

Device coverage and benefit routing vary by plan.

Sources for context

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Imaging, genetics & laboratory

Medical genetics & genomics

A genetic test request lists a diagnosis but not how the result would change care.

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Fictional workflow example

Hereditary breast and ovarian cancer risk evaluation

Care requested
A hereditary cancer evaluation and targeted BRCA-related testing request after counseling.
What needs attention
The family history and expected effect on management are not clearly linked.

Staff prepares

  • Organize the pedigree summary, relevant findings and prior tests.
  • Flag missing counseling or management information for review.

Physician reviews

  • Confirm the reason for testing and its potential effect on care.

The platform does not interpret variants or establish a genetic diagnosis.

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Medical specialties

Nephrology

A transplant evaluation request is confused with approval for the transplant itself.

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Fictional workflow example

Kidney transplant review

Care requested
A nephrologist coordinates a kidney transplant evaluation.
What needs attention
The referral does not clearly identify the stage of the request.

Staff prepares

  • Separate evaluation records from the later transplant request.
  • Track the center documents, owner and outstanding items.

Physician reviews

  • Confirm the clinical summary and the scope of the request.

Transplant candidacy is decided by the transplant program, not by Asclepius.

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Surgical specialties

Neurological surgery

A spine procedure request lacks a clear match between symptoms, findings and the requested level.

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Fictional workflow example

Cervical fusion review

Care requested
A neurosurgeon requests cervical decompression and fusion.
What needs attention
The examination and imaging evidence are not presented together.

Staff prepares

  • Organize the ordered procedure, examination, imaging and available prior care.
  • Flag inconsistent levels or missing source records for review.

Physician reviews

  • Verify the proposed procedure and its patient-specific rationale.

Urgency and surgical planning remain with the treating surgeon.

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Medical specialties

Neurology

A migraine treatment request is returned for missing headache history or prior-treatment evidence.

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Fictional workflow example

Chronic migraine treatment

Care requested
A neurologist requests prescribed botulinum toxin treatment.
What needs attention
The chart mentions a headache diary that is not in the packet.

Staff prepares

  • Link documented headache frequency, prior therapy and the proposed treatment.
  • Flag the missing diary and prepare the relevant evidence list.

Physician reviews

  • Verify the headache history and treatment rationale.

Asclepius does not infer chronic migraine or create a diary.

Sources for context

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Imaging, genetics & laboratory

Nuclear medicine

A PET request is reviewed without the pathology or previous imaging that explains its purpose.

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Fictional workflow example

PET/CT documentation review

Care requested
A nuclear medicine team prepares a prescribed oncology PET/CT.
What needs attention
The request lacks the linked diagnosis and earlier study report.

Staff prepares

  • Organize available pathology, prior imaging and the order.
  • Flag missing records and the question the ordering team wants answered.

Physician reviews

  • Confirm the indication and relevant treatment context.

Tracer selection and interpretation remain with the clinical team.

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Surgical specialties

Obstetrics & gynecology

A fibroid procedure request omits how symptoms affect the patient and what records support the request.

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Fictional workflow example

Symptomatic fibroid treatment

Care requested
A gynecologist requests a prescribed procedure for symptomatic fibroids.
What needs attention
The order is not linked to the imaging and symptom record.

Staff prepares

  • Organize imaging, symptoms and relevant treatment notes.
  • Ask staff for missing records and draft the documented rationale.

Physician reviews

  • Verify the symptoms and reason for the selected procedure.

The clinician and patient choose care; the system does not infer reproductive preferences.

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Acute, rehabilitation & continuing care

Occupational & environmental medicine

Treatment follow-up requires the same dated records to be assembled repeatedly.

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Fictional workflow example

Work-related rehabilitation request

Care requested
An occupational clinician recommends further rehabilitation after an injury.
What needs attention
The current functional assessment is absent from the request.

Staff prepares

  • Organize the injury course, available therapy reports and current restrictions.
  • Assign the missing assessment task and record the reviewed response.

Physician reviews

  • Verify functional status and the proposed rehabilitation.

Workers’ compensation rules and integrations require separate validation; the source is a health-plan example only.

Sources for context

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Surgical specialties

Ophthalmology

A functional eyelid request is returned because a visual field study is missing.

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Fictional workflow example

Eyelid surgery documentation

Care requested
An ophthalmologist requests surgery for documented visual obstruction.
What needs attention
The relevant visual field report has not been linked.

Staff prepares

  • Organize the examination, available field study and photographs.
  • Flag the missing report and preserve its source when added.

Physician reviews

  • Confirm functional impact and the requested procedure.

The cited Medicare outpatient program is setting-specific and does not apply to every plan.

Sources for context

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Surgical specialties

Orthopaedic surgery

A joint replacement request is returned because prior conservative care is not fully documented.

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Fictional workflow example

Knee replacement authorization

Care requested
An orthopaedic surgeon has recommended knee arthroplasty.
What needs attention
Outside physical therapy notes are absent from the request.

Staff prepares

  • Link imaging, functional limitations and existing non-surgical treatment records.
  • Flag the outside therapy report and any unexplained gaps.

Physician reviews

  • Confirm the indication and patient-specific treatment history.

The surgeon determines whether surgery is appropriate; payer criteria are not treatment advice.

Sources for context

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Surgical specialties

Otolaryngology / ENT

Sinus surgery review pauses because medication dates and imaging findings are hard to reconcile.

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Fictional workflow example

Endoscopic sinus surgery

Care requested
An ENT surgeon requests a prescribed sinus procedure.
What needs attention
The CT report is present, but earlier treatment dates are incomplete.

Staff prepares

  • Build a sourced timeline of symptoms, treatment and imaging.
  • Flag missing dates or conflicts for staff rather than filling them in.

Physician reviews

  • Confirm the diagnosis summary and procedure rationale.

Clinical decisions and the extent of surgery remain with the surgeon.

Sources for context

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Acute, rehabilitation & continuing care

Pain medicine

A procedure request is held because earlier care and the relevant imaging are not linked.

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Fictional workflow example

Facet intervention request

Care requested
A pain specialist has ordered a facet intervention.
What needs attention
The clinical evaluation and prior-treatment records are incomplete in the packet.

Staff prepares

  • Collect the ordered service and available supporting records.
  • Show staff the specific gaps and the payer response when recorded.

Physician reviews

  • Confirm the clinical indication and appropriate next action.

The Medicare hospital outpatient program is setting-specific; other criteria must be verified.

Sources for context

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Imaging, genetics & laboratory

Pathology & laboratory medicine

A molecular test denial cannot be resolved from the laboratory report alone.

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Fictional workflow example

Tumor profiling denial

Care requested
A tumor profiling claim is denied for missing clinical context.
What needs attention
The order lacks the linked diagnosis and intended management question.

Staff prepares

  • Match the test order, available pathology and clinician’s stated purpose.
  • Draft a focused evidence response and flag missing clinical context.

Physician reviews

  • Confirm how the requested testing relates to the care plan.

Asclepius does not interpret tumor variants or automatically validate billing codes.

Sources for context

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Medical specialties

Pediatrics

Therapy continuation requests need progress records from outside providers.

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Fictional workflow example

Pediatric speech therapy continuation

Care requested
A pediatric clinician supports continued prescribed speech therapy.
What needs attention
The most recent therapist progress report is missing.

Staff prepares

  • Organize the referral, therapy plan and available progress records.
  • Assign staff the specific missing-report task.

Physician reviews

  • Confirm the functional concern and ongoing clinical need.

Age, developmental needs and plan benefits require individual review.

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Acute, rehabilitation & continuing care

Physical medicine & rehabilitation

A therapy extension is denied because progress and functional goals are not clear in the packet.

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Fictional workflow example

Rehabilitation continuation

Care requested
A physiatrist supports further prescribed physical therapy.
What needs attention
Recent progress measurements and goals are missing.

Staff prepares

  • Bring the plan, prior visits and available functional measures together.
  • Flag missing progress records and track the extension request.

Physician reviews

  • Confirm the functional goals and ongoing skilled need.

Maintenance and improvement pathways need the applicable plan review; no progress is invented.

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Acute, rehabilitation & continuing care

Physical, occupational & speech therapy

Continued visits are questioned when the request does not show distinct goals and documented progress.

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Fictional workflow example

Therapy visit extension

Care requested
A treating therapist requests additional visits under the established plan.
What needs attention
The packet omits recent progress and the updated functional goals.

Staff prepares

  • Organize the plan, available visit records and measured progress.
  • Flag missing reports and distinguish each discipline’s work.

Physician reviews

  • The responsible licensed clinician verifies goals and ongoing need.

Therapist and physician review requirements vary by service and plan.

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Surgical specialties

Plastic & reconstructive surgery

A functional procedure is treated as cosmetic when the submitted record lacks the functional evidence.

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Fictional workflow example

Functional eyelid surgery

Care requested
A reconstructive surgeon requests functional eyelid surgery.
What needs attention
The request lacks relevant photographs and functional testing.

Staff prepares

  • List the existing functional findings, photographs and test reports.
  • Keep missing items visible for staff before packet completion.

Physician reviews

  • Confirm the functional impairment and clinical reason for surgery.

Only medically relevant photographs are selected; cosmetic exclusions need separate review.

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Acute, rehabilitation & continuing care

Podiatry & wound care

An advanced wound treatment request lacks a consistent record of wound size and earlier care.

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Fictional workflow example

Diabetic foot wound treatment

Care requested
A wound clinician requests a prescribed skin substitute.
What needs attention
Some dated wound measurements and standard-care notes are missing.

Staff prepares

  • Organize available measurements, treatment records and relevant photographs.
  • Flag missing evidence and prepare the reviewed attachment list.

Physician reviews

  • Confirm the wound history and the proposed treatment rationale.

Product coverage and wound care decisions require individual review.

Sources for context

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Acute, rehabilitation & continuing care

Preventive medicine & population health

A screening claim is disputed because the earlier risk history or procedure classification is unclear.

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Fictional workflow example

Colorectal screening review

Care requested
A preventive care team reviews a denied colorectal screening claim.
What needs attention
Family history and the earlier screening date are not clearly linked.

Staff prepares

  • Organize verified screening history and the actual reason for the service.
  • Flag classification questions for qualified billing review.

Physician reviews

  • Confirm the clinical history when clarification is needed.

The system does not relabel a diagnostic service as preventive to obtain payment.

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Medical specialties

Psychiatry

A TMS request requires rebuilding medication trials and symptom scores from separate notes.

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Fictional workflow example

TMS authorization

Care requested
A psychiatrist orders transcranial magnetic stimulation for depression.
What needs attention
Medication durations and baseline scores are incomplete.

Staff prepares

  • Organize available trials, outcomes and dated assessment scores.
  • Keep missing durations and scores visible for staff follow-up.

Physician reviews

  • Confirm the current episode, treatment history and clinical rationale.

The psychiatrist determines appropriateness; sensitive records require appropriate access and selection.

Sources for context

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Medical specialties

Pulmonology

A plan requests more information about asthma control and earlier treatment despite a long chart.

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Fictional workflow example

Asthma escalation request

Care requested
A pulmonologist requests a prescribed asthma biologic.
What needs attention
The referral does not include the dated controller history.

Staff prepares

  • Organize available medication and exacerbation evidence.
  • Track the staff follow-up request and response reference in one case.

Physician reviews

  • Confirm treatment response and the concise clinical summary.

Payer criteria and required biomarkers depend on the specific drug and plan.

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Medical specialties

Radiation oncology

A treatment-planning request lacks a clear comparison and supporting planning records.

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Fictional workflow example

IMRT request

Care requested
A radiation oncologist requests intensity modulated radiation therapy.
What needs attention
The packet does not yet include the planning explanation for protecting nearby structures.

Staff prepares

  • Collect the prescription and the available planning evidence.
  • Flag missing planning records for the treatment team before drafting the request.

Physician reviews

  • Verify the patient-specific reason for the proposed technique.

The system does not produce a radiation plan or replace dosimetric review.

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Surgical specialties

Reproductive endocrinology & fertility

Medical and pharmacy approvals become disconnected during a time-sensitive fertility cycle.

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Fictional workflow example

IVF cycle coordination

Care requested
A fertility specialist has planned an IVF cycle.
What needs attention
The procedure authorization reference is not linked to the medication request.

Staff prepares

  • Keep the verified benefit, cycle plan and authorization references together.
  • Flag benefit exclusions or missing approvals before staff proceeds.

Physician reviews

  • Confirm the proposed cycle and clinically essential questions.

Benefits and state requirements vary; clinical necessity does not create an excluded benefit.

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Medical specialties

Rheumatology

A step-therapy denial asks the practice to prove treatments already tried.

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Fictional workflow example

Rheumatoid arthritis denial review

Care requested
A biologic request is denied for incomplete prior-treatment evidence.
What needs attention
An intolerance is described in a visit note but absent from the original packet.

Staff prepares

  • Link the denial reason to dated medication and intolerance records.
  • Draft a focused response with only relevant attachments and an unresolved-items list.

Physician reviews

  • Verify the history and the patient-specific clinical argument.

No failed drug trial or contraindication is assumed from an empty field.

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Medical specialties

Sleep medicine

A device request is held while staff searches for the sleep study and follow-up documentation.

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Fictional workflow example

Sleep apnea equipment request

Care requested
A sleep clinician orders positive airway pressure equipment.
What needs attention
The order is present, but the sleep study report has not been linked.

Staff prepares

  • Match the order, sleep study and relevant visit records.
  • Show staff what is still needed for the selected payer pathway.

Physician reviews

  • Verify the clinical summary and the prescribed equipment.

A device order alone is not proof that every coverage requirement is met.

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Surgical specialties

Thoracic & cardiac surgery

A planned procedure needs imaging evidence that is spread across referring organizations.

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Fictional workflow example

Preoperative lung cancer staging

Care requested
A thoracic surgeon orders a staging PET/CT before a treatment decision.
What needs attention
Earlier CT and biopsy records have not been linked to the order.

Staff prepares

  • Bring available pathology and imaging into a reviewable source list.
  • Flag outside records and keep the assigned follow-up visible.

Physician reviews

  • Confirm the study purpose and the documented surgical decision it informs.

Surgical planning and cancer stage require clinician verification.

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Surgical specialties

Transplant medicine & surgery

Different requests for evaluation, surgery and follow-up are mixed into one status.

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Fictional workflow example

Lung transplant coordination

Care requested
A transplant team coordinates an evaluation and later procedure request.
What needs attention
The current request does not distinguish evaluation from the planned procedure.

Staff prepares

  • Keep each request and its supporting center records distinct.
  • Track ownership, outstanding items and recorded responses by request.

Physician reviews

  • Confirm the clinical summary and request scope.

Selection, candidacy and allocation decisions remain with authorized transplant teams.

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Surgical specialties

Urology

A procedure review lacks the symptom and prior-treatment evidence already present in the chart.

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Fictional workflow example

BPH procedure request

Care requested
A urologist recommends a procedure for bothersome urinary symptoms.
What needs attention
The request does not include the documented medication response and evaluation.

Staff prepares

  • Organize the ordered procedure, evaluation and existing treatment history.
  • Flag missing measurements or conflicting procedure details.

Physician reviews

  • Confirm the clinical rationale and proposed procedure.

The exact procedure and plan determine the relevant criteria.

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Surgical specialties

Vascular surgery

A vein procedure request is returned for missing ultrasound findings and symptom history.

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Fictional workflow example

Symptomatic vein treatment

Care requested
A vascular surgeon requests a prescribed vein ablation procedure.
What needs attention
The duplex report and documented prior management are not together.

Staff prepares

  • Organize the duplex report, symptoms and available treatment records.
  • Flag missing laterality or source evidence before final review.

Physician reviews

  • Verify the clinical reason and the planned treatment site.

Cosmetic and medical indications must be distinguished; coverage is plan-specific.

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How to read these examples

These 44 fictional workflow examples show how administrative preparation and focused clinical review may differ by care area. They are not treatment recommendations, validated specialty outcomes or insurance coverage decisions. Sources provide context only and do not imply endorsement. The treating clinician, current plan, source records and applicable effective policies determine the real case.

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