Calculation Methodology The measurement begins from the date Insurer receives the request and ends the date Insurer makes a final decision and communicates such decision to the requesting Provider. Requests for prior authorization pending additional information from the requesting Provider are not included in the measurement so long as the prior authorization was extended appropriately as described in 42 CFR 438.210. Prior authorizations for which Insurer extended beyond the fourteen (14) Calendar Days as permitted by law are excluded from this measurement. For purposes of determining compliance with this PG and for determining any financial consequences, Insurer shall report the percentage of prior authorizations processed within fourteen (14) Calendar Days. Performance reported in any other manner, including the number of Calendar Days to process one hundred percent (100%) of prior authorizations is insufficient to meet the requirements of this PG. Financial Consequences shall be calculated as the difference between the guarantee and the actual result, multiplied by one thousand dollars ($1,000). Related Contract Reference: Section 26 Expedited, Non-prescription Drug Prior Authorization Processing Timeliness Insurer shall process 100 percent (100%) of all expedited, non-prescription drug prior authorizations within seventy-two (72) hours. Financial Consequences: one thousand dollars ($1,000) per percentage point below guarantee. Calculation Methodology The measurement begins from the date and time Insurer receives the request and ends the date and time Insurer makes a final decision and communicates such decision to the requesting Provider. Requests for prior authorization pending additional information from the requesting Provider are not included in the measurement so long as the prior authorization was extended appropriately as described in 42 CFR 438.210. Prior authorizations for which Insurer extended beyond the seventy-two (72) hours as permitted by law are excluded from this measurement. For purposes of determining compliance with this PG and for determining any financial consequences, Insurer shall report the percentage of prior authorizations processed within seventy-two (72) hours. Performance reported in any other manner, including
Calculation Methodology The measurement begins from the date Insurer receives the request and ends the date Insurer makes a final decision and communicates such decision to the requesting Provider. Requests for prior authorization pending additional information from the requesting Provider are not included in the measurement so long as the prior authorization was extended appropriately as described in 42 CFR 438.210. Prior authorizations for which Insurer extended beyond the fourteen (14) Calendar Days as permitted by law are excluded from this measurement. For purposes of determining compliance with this PG and for determining any financial consequences, Insurer shall report the percentage of prior authorizations processed within fourteen (14) Calendar Days. Performance reported in any other manner, including the number of Calendar Days to process one hundred percent (100%) of prior authorizations is insufficient to meet the requirements of this PG. Financial Consequences shall be calculated as the difference between the guarantee and the actual result, multiplied by one thousand dollars ($1,000). Related Contract Reference: Section 26 Expedited, Non-prescription Drug Prior Authorization Processing Timeliness Insurer shall process 100 percent (100%) of all expedited, non-prescription drug prior authorizations within seventy-two (72) hours. Financial Consequences: one thousand dollars ($1,000) per percentage point below guarantee. Calculation Methodology The measurement begins from the date and time Insurer receives the request and ends the date and time Insurer makes a final decision and communicates such decision to the requesting Provider. Requests for prior authorization pending additional information from the requesting Provider are not included in the measurement so long as the prior authorization was extended appropriately as described in 42 CFR 438.210. Prior authorizations for which Insurer extended beyond the seventy-two (72) hours as permitted by law are excluded from this measurement. For purposes of determining compliance with this PG and for determining any financial consequences, Insurer shall report the percentage of prior authorizations processed within seventy-two (72) hours. Performance reported in any other manner, including
AttachmentCPerformanceGuarantees.docx