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Enhancements in Prior Authorization Processing and Communication: Status Update

Our prior authorization processing has seen significant improvements, including the addition of 12 staff members to handle fax submissions, management of ongoing faxes, and a proactive approach with 18 one-on-one outreach sessions since January 3rd. We have successfully cleared outstanding hard copy faxes and gathered detailed data on call volumes and abandonment rates. Moreover, technical issues related to electronic submissions have been resolved, and ongoing provider communications have been enhanced. These efforts aim to streamline processes and improve service efficiency for all stakeholders.

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Enhancements in Prior Authorization Processing and Communication: Status Update

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  1. Prior Authorization Processing Timeframes Status Completed: • Increased staff dedicated to processing faxes by 12 to clear out unattached fax inventory • Increased CSR staff to manage ongoing incoming faxes • Increased clinical staff • Proactive outreach: 18 one on one sessions since 1/3 • Attached and reduced all outstanding hard copy faxes • Reduced inventory (all service types)

  2. Prior Authorization Electronic Submission • Completed • Timing out when submitting PA - additional CPU added 1/16 • Reverse proxy error – technical changes resolved 1/16 • In Process • Continued stay capability – 2/20 • Character length in “notes” field – 2/20 • Release of information checkbox – to be removed 2/20 • Size limitation of file attachments at 4mgb – under evaluation

  3. Prior Authorization Fax and Phone Access • Call Volume: • Dec (736/day) • Jan (626/day) • Jan 23 - 27th (605/day) • Abandonment Rate: • Dec (1.89%) • Jan 1 - 20th (9.30%) • Jan 23 - 27th (2.34%) • Calls answered in 60 seconds: Dec and Jan (94-98%) • Average wait time: Dec (16 seconds), Jan (7 seconds) • Fax busy: Dec (15%) to Jan (3%)

  4. Prior Authorization Status Completed: • Last 6 months of Magellan data (pre 12/5) loaded In Process: • Ongoing research with individual facilities • Eliminating duplicate cases with multiple PA numbers for same dates of service or recipient

  5. Provider Communication Completed: • Higher frequency of provider communications In Process: • Ongoing education and web messages to assist with; • definition of determinations, faxing tips, web submission tips • viewing and searching authorizations in portal • units available to show when claim is adjudicated • portal showing date of decision or rationale

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