MA HMO 2025 Prior Authorizations ,,,,,MA PPO 2025 Prior Authorizations ,,,
,,,,,,,,
"Standard PA, Approved",,,,,"Standard PA, Approved",,,
,Approved,Total PA,% Approved,,,Approved,Total PA,% Approved
Non-SRF,1398,1503,92.64%,,Non-SRF,1804,2014,89.53%
SRF,437,480,91.04%,,SRF,1374,1547,88.59%
Grand Total,1835,1983,,,Grand Total,3178,3561,
,,,,,,,,
"Standard PA, Denied",,,,,"Standard PA, Denied",,,
,Denied,Total PA,% Denied,,,Denied,Total PA,% Denied
Non-SRF,105,1503,6.96%,,Non-SRF,210,2014,10.42%
SRF,43,480,8.96%,,SRF,173,1547,11.15%
Grand Total,148,1983,,,Grand Total,383,3561,
,,,,,,,,
"Standard PA, Approved After Appeal ",,,,,"Standard PA, Approved After Appeal ",,,
,Approved,Total Appeal,% Approved,,,Approved,Total Appeal,% Approved
Non-SRF,11,11,100.00%,,Non-SRF,30,38,78.95%
SRF,4,6,66.67%,,SRF,20,29,68.97%
Grand Total,15,17,,,Grand Total,50,67,
,,,,,,,,
"Expedited PA, Approved",,,,,"Expedited PA, Approved",,,
,Approved,Total PA,% Approved,,,Approved,Total PA,% Approved
Non-SRF,123,135,89.78%,,Non-SRF,185,203,90.24%
SRF,36,39,92.31%,,SRF,123,155,79.35%
Grand Total,159,174,,,Grand Total,308,358,
,,,,,,,,
"Expedited PA, Denied",,,,,"Expedited PA, Denied",,,
,Denied,Total PA,% Denied,,,Denied,Total PA,% Denied
Non-SRF,12,135,8.76%,,Non-SRF,18,203,8.78%
SRF,3,39,7.69%,,SRF,32,155,20.65%
Grand Total,15,174,,,Grand Total,50,358,
,,,,,,,,
"PA, Review Extended and Approved",,,,,"PA, Review Extended and Approved",,,
,Reviews Extended,Total PA,% Approved,,,Reviews Extended,Total PA,% Approved
Non-SRF,93,115,80.87%,,Non-SRF,92,136,67.65%
SRF,37,43,86.05%,,SRF,79,129,61.24%
Grand Total,130,158,,,Grand Total,171,265,
,,,,,,,,
"Standard PA, Average TAT (Hours)",,,,,"Standard PA, Average TAT (Hours)",,,
,Average TAT,,,,,Average TAT,,
Non-SRF,168:28:24,,,,Non-SRF,118:45:42,,
SRF,174:51:03,,,,SRF,117:52:37,,
,,,,,,,,
"Expedited PA, Average TAT (Hours)",,,,,"Expedited PA, Average TAT (Hours)",,,
,Average TAT,,,,,Average TAT,,
Non-SRF,29:37:49,,,,Non-SRF,27:01:18,,
SRF,12:56:27,,,,SRF,33:18:03,,
,,,,,,,,
"Standard PA, Median TAT (Hours)",,,,,"Standard PA, Median TAT (Hours)",,,
,Median TAT,,,,,Median TAT,,
Non-SRF,145:53:25,,,,Non-SRF,75:46:58,,
SRF,168:03:34,,,,SRF,74:56:22,,
,,,,,,,,
"Expedited PA, Median TAT (Hours)",,,,,"Expedited PA, Median TAT (Hours)",,,
,Median TAT,,,,,Median TAT,,
Non-SRF,4:56:06,,,,Non-SRF,6:04:36,,
SRF,4:56:12,,,,SRF,4:51:03,,
,,,,,,,,
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,,,,,,,,