CTHMO 2025 Prior Authorizations,,,,,CTPPO 2025 Prior Authorizations,,,
,,,,,,,,
"Standard PA, Approved ",,,,,"Standard PA, Approved ",,,
,Approved,Total PA,% Approved,,,Approved,Total PA,% Approved
Non-SRF,1331,1546,86.09%,,Non-SRF,1500,1672,89.71%
SRF,756,902,83.81%,,SRF,554,638,86.70%
Grand Total,2087,2448,,,Grand Total,2054,2310,
,,,,,,,,
"Standard PA, Denied",,,,,"Standard PA, Denied",,,
,Denied,Total PA,% Denied,,,Denied,Total PA,% Denied
Non-SRF,215,1546,13.91%,,Non-SRF,172,1672,10.29%
SRF,146,902,16.19%,,SRF,84,638,13.15%
Grand Total,361,2448,,,Grand Total,256,2310,
,,,,,,,,
"Standard PA, Approved After Appeal ",,,,,"Standard PA, Approved After Appeal ",,,
,Approved,Total Appeal,% Approved,,,Approved,Total Appeal,% Approved
Non-SRF,25,42,59.52%,,Non-SRF,28,41,68.29%
SRF,14,20,70.00%,,SRF,15,19,78.95%
Grand Total,39,62,,,Grand Total,43,60,
,,,,,,,,
"Expedited PA, Approved",,,,,"Expedited PA, Approved",,,
,Approved,Total PA,% Approved,,,Approved,Total PA,% Approved
Non-SRF,77,92,83.70%,,Non-SRF,124,131,93.94%
SRF,61,64,95.31%,,SRF,38,40,95.00%
Grand Total,138,156,,,Grand Total,162,171,
,,,,,,,,
"Expedited PA, Denied",,,,,"Expedited PA, Denied",,,
,Denied,Total PA,% Denied,,,Denied,Total PA,% Denied
Non-SRF,15,92,16.30%,,Non-SRF,7,131,5.30%
SRF,3,64,4.69%,,SRF,2,40,5.00%
Grand Total,18,156,,,Grand Total,9,171,
,,,,,,,,
"PA, Review Extended and Approved",,,,,"PA, Review Extended and Approved",,,
,Reviews Extended,Total PA,% Approved,,,Reviews Extended,Total PA,% Approved
Non-SRF,18,52,34.62%,,Non-SRF,73,84,86.90%
SRF,13,36,36.11%,,SRF,28,36,77.78%
Grand Total,31,88,,,Grand Total,101,120,
,,,,,,,,
"Standard PA, Average TAT (Hours)",,,,,"Standard PA, Average TAT (Hours)",,,
,Average TAT,,,,,Average TAT,,
Non-SRF,107:37:32,,,,Non-SRF,115:00:14,,
SRF,112:45:41,,,,SRF,94:51:01,,
,,,,,,,,
"Expedited PA, Average TAT (Hours)",,,,,"Expedited PA, Average TAT (Hours)",,,
,Average TAT,,,,,Average TAT,,
Non-SRF,30:52:41,,,,Non-SRF,43:27:08,,
SRF,21:16:57,,,,SRF,30:36:42,,
,,,,,,,,
"Standard PA, Median TAT (Hours)",,,,,"Standard PA, Median TAT (Hours)",,,
,Median TAT,,,,,Median TAT,,
Non-SRF,28:10:45,,,,Non-SRF,35:45:03,,
SRF,48:25:15,,,,SRF,27:44:00,,
,,,,,,,,
"Expedited PA, Median TAT (Hours)",,,,,"Expedited PA, Median TAT (Hours)",,,
,Median TAT,,,,,Median TAT,,
Non-SRF,18:50:56,,,,Non-SRF,12:33:16,,
SRF,16:51:56,,,,SRF,5:16:07,,
,,,,,,,,
Key:,,,,,,,,
PA- prior authorization ,,,,,,,,
SRF- members who have a social risk factor,,,,,,,,
non- SRF- members who do not have a social risk factors,,,,,,,,
Standard PA turn around time- 14 calendar days,,,,,,,,
Expediaited PA turn around time- 72 hours,,,,,,,,
,,,,,,,,
SRF is defined as: (1) receipt of the low-income subsidy or being dually eligible for Medicare and Medicaid (LIS/DE); or (2) having a disability (determined using the variable original reason for entitlement code (OREC) for Medicare using the information from the Social Security Administration and Railroad Retirement Board record systems,,,,,,,,