This performance measure is important because prior authorization determinations of medical necessity are expected to adhere to Medicaid Rules and Federal Guidelines specified completion timeframes.
Medical determinations are made using evidence-based clinical guidelines. Reaching a goal of 100% is heavily dependent on prior authorization request volumes, receipt of all clinical documentation from requesting provider, adequate staffing, and accurate data analysis.
SFY22 Q2 is 100.0% and reflects reaching the established goal of 100% for two consistent quarters. The trend line for this measure has remained consistently high since 2019.
Narrative last updated: 02/15/22