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Prior Authorization Statistics Needed by TMA


June 7, 2022
 

Nashville, TN — The Tennessee Medical Association needs assistance from medical practice with its advocacy to try to reduce the burden of health plan prior authorization. TMA needs to know how practices submit prior authorization requests for procedures/services and drugs. Also needed are statistics on prior authorization approval rates.

We ask practices to keep data for a period of time (month, quarter, 6 months, etc.) and then provide data to the Prior Authorization Workgroup facilitated by TMA regarding:

  1. Whether each prior authorization request is submitted via the health plan’s electronic portal, or phone, or other means.
  2. Whether initial approval rates for each service/drug is higher if the prior auth request is submitted electronically through the health plan’s portal.
  3. What services/drugs for which the practice commonly submits prior authorization.
  4. The number of requests for prior authorization for each service/drug for a given period of time.
  5. The rates of initial approval for each service/drug requiring prior authorization.
  6. The rates of approval after appeal for each service/drug requiring prior authorization.

Below is a sample log set up as to how a practice might track this information:

If your practice would agree to track this information then submit it to TMA, please contact Tabitha Lara, TMA Director of Insurance Affairs, at Tabitha.lara@tnmed.org.