Patient
S.T. (de-identified)
PA-99604 Prior Auth Detail
LYA-Neuro 3 | Cigna | Status: Draft
Next action: Complete medical necessity statement
Policy: Cigna policy CG-PHAR-12 (revised Feb 2026)
Patient and Case Context
De-identified snapshot used to justify authorization request.
Diagnosis
Relapsing neurologic disease with recent progression
Urgency
High - frequent relapse activity
Benefit type
Commercial, prior auth draft
PA Checklist and Documents
Submission-readiness controls to prevent avoidable rework.
Neurology note
Status: Attached
Source: Visit 2026-02-17
MRI report
Status: Attached
Source: Imaging 2026-02-12
Medical necessity letter
Status: Draft
Source: Awaiting provider final review
Attestation form
Status: Missing
Source: Signature pending
Payer Criteria Mapping
Explicit mapping of policy criteria to supporting evidence.
Relapse frequency requirement
Status: Met
Evidence: Neurology note + relapse log
MRI activity
Status: Met
Evidence: Recent MRI report
Prior therapy intolerance
Status: Met
Evidence: Adverse reaction documentation
Signed specialist attestation
Status: Needs Evidence
Evidence: Not yet signed
Denial Risk Signals
- Unsigned attestation will trigger automatic rejection
- Potential question on relapse date documentation consistency
Timeline
Submission and rework events across this PA case.
Draft opened
2026-02-18
Complete
Clinical packet build
2026-02-19
Complete
Provider attestation
2026-02-22
Pending
Initial submit
2026-02-23
Planned
Communication Log
Payer, field, and office touchpoints tied to this authorization.
Internal hub note
Owner: PA specialist
Medical necessity draft generated and routed.
MSL consult
Owner: Medical liaison
Provided citation-aligned disease burden references.
Provider office
Owner: Practice manager
Signature block reserved for today 4 PM.
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Add Missing Document Detail
Capture missing evidence and assignment for completion.
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Document call outcomes and required next actions.