You're seeing a real patient case flow through each AI node — from raw doctor's notes to a complete, submission-ready insurance form.
Sample TKR case processed through 4 pipeline nodes against Medi Assist.
Viewing pre-loaded sample results. to see live pipeline output.
Node 1 · Read the Doctor's Notes
Ramesh Kumar
62y Male · Severe pain right knee x 6 months, progressively worsening, unable to walk >100m
Est. Cost
₹3,50,000
Severe Osteoarthritis Right Knee
M17.11HIGHTotal Knee Replacement — Right5-7 days
Essential Hypertension (I10) · Type 2 Diabetes Mellitus (E11.9)
CBC
Hb 13.2, WBC 7800, Plt 2.4L
Normal — no contraindication to surgery
FBS
142 mg/dL
Mildly elevated — diabetes control should be optimized pre-operatively
Abnormal
HbA1c
7.1%
Fair glycemic control — acceptable for elective surgery per anesthesia clearance
Abnormal
KFT
Cr 1.0, BUN 18
Normal renal function
PT/INR
1.1
Normal coagulation — safe for surgery
X-ray
Kellgren-Lawrence Grade IV — surgical indication confirmed
2D
Normal cardiac function — cleared for anesthesia
Medical Necessity
62-year-old male with severe osteoarthritis of the right knee (Kellgren-Lawrence Grade IV) presenting with progressive pain and functional limitation despite 4 months of conservative management including NSAIDs and 16 sessions of physiotherapy (VAS improved only from 7/10 to 6/10). X-ray confirms severe joint space narrowing with subchondral sclerosis, osteophyte formation, and varus malalignment. Patient is unable to walk more than 100 meters and pain disturbs sleep. Conservative treatment has been adequately attempted and failed. Total knee replacement is medically necessary to restore mobility and quality of life. Comorbidities (HTN and DM) are well-controlled with ASA Grade II clearance from anesthesia.
62M with severe OA right knee (KL Grade IV, M17.11) — conservative treatment failed after 4 months. TKR recommended. Comorbidities: HTN (controlled), DM Type 2 (HbA1c 7.1%). Pre-anesthetic fitness: ASA Grade II. Estimated cost: ₹3,50,000.
Node 2 · Check Completeness
88
GREEN — Ready
Ready to submit. Completeness score 88/100. Two minor query risks identified — both can be pre-empted with existing documentation. Recommend including a one-paragraph cover note addressing the HbA1c clearance.
Medi Assist
Response: 4.2h
Query rate: 38%
✓Doctor's referral letter— Contains diagnosis, procedure recommendation, and clinical justification
✓X-ray Right Knee— AP/Lateral views with KL Grade IV findings documented
✓Blood work (CBC, FBS, HbA1c, KFT, LFT, PT/INR)— All reports within acceptable ranges for elective surgery
✓ECG— Normal sinus rhythm
✓2D Echocardiography— LVEF 60%, normal function
✓Pre-anesthetic fitness certificate— ASA Grade II clearance
✓Physiotherapy records— 16 sessions documented with VAS scores — demonstrates conservative treatment failure
✓Cost estimate on hospital letterhead— Standard format with itemized breakdown
Predicted Query Risks
HbA1c 7.1% — TPA may question surgical fitness with suboptimal diabetes control — 35% — Include endocrinologist clearance note or treating surgeon's written confirmation that HbA1c is acceptable
Conservative treatment duration — some TPAs require 6+ months — 25% — Physiotherapy records already show 4 months with minimal improvement. Emphasize VAS scores in cover letter.
Node 3 · Predict Approval
82
Approval %
Full Approval68%
Partial14%
Query-Back15%
Denial3%
Strong submission with 82% approval probability. Documentation is comprehensive with clear medical necessity. Primary risk is a query on diabetes control, which can be pre-empted. Recommend submitting with a brief cover note.
Risk Factors
Pre-existing conditions (HTN + DM)-8%
Both conditions documented as controlled with ASA Grade II clearance. Include endocrinologist note if available.
HbA1c slightly above 7%-4%
7.1% is within acceptable range for elective orthopedic surgery per most TPA guidelines. Surgeon's written acceptance documented.
Cost estimate at upper range-3%
₹3.5L is within standard TKR range for semi-private room. Itemized breakdown provided.
Positive Factors
Complete documentation set — 8/8 required documents present+15%