Prior Authorization Statistics Sought by TMA
June 7, 2022
Nashville, TN — The Tennessee Medical Association is seeking assistance from state medical practices in attempts to reduce the burden of health plan prior authorization. TMA spicifically needs additional information on how practices submit prior authorization requests for procedures/services and drugs. Also sought are statistics on prior authorization approval rates.
We ask practices to track data for a specified period of time (monthly, quarterly, six-month period, etc.) and provide it to the Prior Authorization Workgroup facilitated by TMA regarding:
- Whether each prior authorization request is submitted via the health plan’s electronic portal, or phone, or other means.
- Whether initial approval rates for each service/drug is higher if the prior authorization request is submitted electronically through the health plan’s portal.
- The services and/or drugs for which the practice commonly submits prior authorization requests.
- The number of requests for prior authorization for each service/drug for a given period of time.
- The rates of initial approval for each service/drug requiring prior authorization.
- The rates of approval after appeal for each service/drug requiring prior authorization.
Below is a sample log to display the ways in which a practice might capture this information:
If your practice is willing to track this information, please contact Tabitha Lara, TMA Director of Insurance Affairs, at email@example.com.