One Care 2025 Prior Authorizations,,,
,,,
"Standard PA, Approved",,,
,Approved,Total PA,% Approved
Non-SRF,0,0,0.00%
SRF,16426,17562,93.38%
Grand Total,16426,17562,
,,,
"Standard PA, Denied",,,
,Denied,Total PA,% Denied
Non-SRF,0,0,0.00%
SRF,1136,17562,6.46%
Grand Total,1136,17562,
,,,
"Standard PA, Approved After Appeal ",,,
,Approved,Total Appeal,% Approved
Non-SRF,0,0,0.00%
SRF,117,169,69.23%
Grand Total,117,169,
,,,
"Expedited PA, Approved",,,
,Approved,Total PA,% Approved
Non-SRF,0,0,0.00%
SRF,1262,1344,93.90%
Grand Total,1262,1344,
,,,
"Expedited PA, Denied",,,
,Denied,Total PA,% Denied
Non-SRF,0,0,0.00%
SRF,82,1344,6.10%
Grand Total,82,1344,
,,,
"PA, Review Extended and Approved",,,
,Approved,Total PA,% Approved
Non-SRF,0,0,0.00%
SRF,1,3,33.33%
Grand Total,1,3,
,,,
"Standard PA, Average TAT (Hours)",,,
,Average TAT,,
Non-SRF,N/A,,
SRF,85:28:23,,
,,,
"Expedited PA, Average TAT (Hours)",,,
,Average TAT,,
Non-SRF,N/A,,
SRF,8:28:44,,
,,,
"Standard PA, Median TAT (Hours)",,,
,Median TAT,,
Non-SRF,N/A,,
SRF,74:09:18,,
,,,
"Expedited PA, Median TAT (Hours)",,,
,Median TAT,,
Non-SRF,N/A,,
SRF,1:32:55,,
,,,
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,,,