TeddyCare ClaimIQ
INTERNAL
David Kim — Senior Reviewer
Senior Review
Submission Confirmation
Senior Review — A-3005 — Karen White
SENIOR_REVIEW_REQUIRED
⚡
Complex
Hospital
Reviewer: David Kim
Patient
Karen White, 73F
Provider
Riverside General
Payer
Medicare Part A
Denial Type
Medical Necessity
Amount
$4,200
Deadline
Apr 10, 2025
AI Confidence
88%
Prepared By
Jessica Torres
Complex Case
— Hospital inpatient admission. AI confidence 88% (below 98% threshold).
Call log verified
— Kepro confirmed appeal process and fax submission.
Appeal Letter
To: Kepro Appeals Department | Re: Appeal for Claim MC-2025-INP-440281 | Patient: Karen White, DOB 06/15/1951...
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Checklist
(8/9 complete)
Call Logs
Case Notes
Senior Review Decision
Review Justification
*
Reviewed appeal letter and supporting documentation. Clinical presentation with creatinine 4.8 and potassium 5.9 clearly meets inpatient criteria. Appeal is well-documented and addresses InterQual criteria directly. Approved for submission.
Approve
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