1. Understanding Prior Authorization (PA):
Determinations Overview:
- By Payer: Gain clarity on how different insurance providers respond to your PA submissions.
- By Drug: Identify which medications encounter the most resistance and approval, allowing for better strategy formulation.
- Denial Reasons by Payer: Delve deep into the specifics of denial reasons to better tailor future submissions.
- Determination Insights: A holistic view of all determinations, helping you make informed decisions.
- PA Volumes: Stay updated on the volume of PA requests, enabling you to allocate resources effectively.
2. Staff Performance Insights:
Throughput and Efficiency:
- Monitor the number of PA requests processed by each staff member to ensure even distribution of workload and identify high performers.
Approval Rate:
- Understand the success rate of your team, tracking which members achieve the highest approval rates. This can highlight areas for further training or best practice sharing.
3. Product Performance Metrics:
Time to Fill:
- Evaluate the efficiency of the product by measuring the time taken from receiving a PA request to its submission, helping pinpoint any potential delays.
Confidence Breakdown:
- Access insights into the confidence levels associated with each answer provided, ensuring consistent and accurate information relay.
Answer Change Rate:
- Monitor the frequency of answer modifications to determine the accuracy and reliability of initial responses.
Channel Submission Volumes:
- Stay informed on the volume of submissions made through various channels, like phone calls, faxes, or ePA, optimizing the channel mix for better outcomes.