ChironAI™ OM · scenario 2 of 7

A utilization review denial

Scenario A fictional case, shown on the synthetic demo clinic.

The scenario

UR denies an MRI. Chiron records the decision, opens an IMR appeal and starts the filing-window alerts. It drafts the medical-necessity rationale from the record, proposes exhibits, and assembles a fingerprinted support packet once the physician has edited and locked each section. Later, when the same MRI is requested again while the denial still binds, Chiron explains why before the RFA goes out.

On screen

Screens from the demo clinic, Chiron Demo Medical Group: the screens this scenario moves through, on the clinic’s own cases. Every patient and case in it is synthetic.

The IMR Appeals board in ChironAI OM. One open appeal, for a denied left L5-S1 transforaminal epidural steroid injection, sits at Packet Assembled with a filing-deadline chip reading 23 days left.
The IMR appeals board, with the filing window on every appeal.
The IMR rationale screen. Six of six sections are drafted and saved; a notice says the rationale is locked because the packet is assembled, and the first section, Diagnosis and Functional Limitations, shows the physician-reviewed text.
The medical-necessity rationale, section by section, locked once the packet is built.
The Treatment and UR screen for the same case. Counters show one open request for authorization and no UR clock at risk; the decided DWC Form RFA is shown read-only beside an MTUS concordance panel that quotes the low back guideline verbatim.
The request for authorization, checked against the MTUS guideline it quotes.

Next scenario

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  2. 02. We reply within two business days to book a time that suits you.
  3. 03. Forty-five minutes: your workflow, the reasoning trace, procurement questions.

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