Patient
R.M. (de-identified)
PA-99271 Prior Auth Detail
LYA-Onco 1 | UnitedHealthcare | Status: Submitted
Next action: Monitor payer portal decision
Policy: UnitedHealthcare policy UHC-SPEC-77 (revised Dec 2025)
Patient and Case Context
De-identified snapshot used to justify authorization request.
Diagnosis
Metastatic solid tumor second-line
Requested site
Hospital outpatient infusion center
Benefit type
Medical benefit
PA Checklist and Documents
Submission-readiness controls to prevent avoidable rework.
Pathology report
Status: Attached
Source: Path report 2026-02-10
Treatment history
Status: Attached
Source: Oncology timeline
Performance status
Status: Attached
Source: Provider note 2026-02-15
Payer Criteria Mapping
Explicit mapping of policy criteria to supporting evidence.
On-label diagnosis and stage
Status: Met
Evidence: Pathology + staging note
Prior regimen exposure
Status: Met
Evidence: Treatment timeline attached
Functional status threshold
Status: Met
Evidence: ECOG documented
Denial Risk Signals
- Low current risk; monitor for additional pathology clarification request
Timeline
Submission and rework events across this PA case.
Case created
2026-02-14
Complete
Submission sent
2026-02-15
Complete
Payer clinical review
2026-02-20
In review
Communication Log
Payer, field, and office touchpoints tied to this authorization.
Payer portal
Owner: Authorization team
Status remains in clinical review queue.
Sales follow-up
Owner: Territory account manager
Shared non-promotional access checklist for office staff.
Add / Correct Information
Click to append missing details and approval-ready notes.
Add Missing Document Detail
Capture missing evidence and assignment for completion.
Add Payer Follow-up Outcome
Document call outcomes and required next actions.