Clinical Services Team: Pharmacy Unit

% of pharmacy prior authorizations processed within 4 and 24 hours

100.0%Jun 2022

Line Bar
Notes on Methodology

Please note that in the chart above:

  • The dotted trendline represents the % of PA processed in 4 hours or less
  • The solid trendline represents the % of PA processed in 24 hours or less

Partners
  • Change Healthcare-Provider Call Center Staff
  • DVHA’s Enrolled Prescribers and Pharmacies
Story Behind the Curve

This performance measure is important because it allows the Pharmacy Unit to ensure that both contractual and Federal requirements are met by our vendor Change Healthcare by monitoring prior authorization (PA) processing turnaround time.

This performance measure shows the percentage of PAs turned around in 24-hour and 4-hour time periods. This time period is measured from the time a PA request is received in the Call Center until a PA determination is made by Call Center staff and a Notice of Decision is issued. Our contract and the CMS requirement are to have all PAs responded to within 24 hours.

The trendline tells us that the average # of PA’s processed within 24-hours is nearly 100% each month. Because of very high compliance, we decided to shorten the time period for measurement to four hours, and happily the turnaround time is still in the high 90th percentile. This not only helps us measure our vendor’s performance, but also helps support our important PA program when speaking with providers and other stakeholders.

Narrative last updated:  12/03/2020

Scorecard Result Container Indicator Measure Action Actual Value Target Value Tag S R I P PM A m/d/yy m/d/yyyy