Prior Authorization Reporting - Patrius
Breadcrumb
Prior Authorization Analysis
Prior Authorization Metrics (Excluding Drugs)
Patrius CY 2025
To comply with the Centers for Medicare and Medicaid Service (CMS) Interoperability and Prior Authorization final rule, Patrius Health is required to annually report aggregated prior authorization metrics on our website. Specifically, this includes a list of all medical items and services (excluding drugs) that require prior authorization, as well as data on prior authorization requests for those items and services (e.g., approvals, denials, etc.) over the previous calendar year.
Publicly reporting these metrics promotes transparency and accountability, helps patients understand prior authorization processes, and enables providers to evaluate payer performance. In addition, metrics can be used to compare plans, programs, and payers.
Prior Authorization data table
| Patrius Service Categories | |
|---|---|
| Advanced Imaging | |
| Behavioral Health Inpatient | |
| Behavioral Health Outpatient | |
| Genetic Testing | |
| Inpatient Medical | |
| Inpatient Surgical | |
| Occupational Therapy (after 20 visits) | |
| Physical Therapy (after 20 visits) | |
| Speech Therapy (after 20 visits) | |
| Standard (non-urgent) Prior Authorization Requests | |||
|---|---|---|---|
| Type of decision | How many times this happened | Out of total requests | Percentage |
| Requests approved | 4,275 | 4,503 | 94.94% |
| Requests denied | 228 | 4,503 | 5.06% |
| Total requests appealed that were initially denied | 30 | 228 | 13.16% |
| Requests approved only after appeal | 29 | 30 | 96.67% |
| Requests approved after time for review was extended | 0 | 4,503 | 0.00% |
| Expedited (urgent) Prior Authorization Requests | |||
|---|---|---|---|
| Type of decision | How many times this happened | Out of total requests | Percentage |
| Requests approved | 107 | 112 | 95.54% |
| Requests denied | 5 | 112 | 4.46% |
| Requests approved after time for review was extended | 0 | 112 | 0.00% |
| Time Between Receiving a Prior Authorization Request and Sending a Decision | ||
|---|---|---|
| Mean (average) | Median (middle) | |
| Time that elapsed between submission of non-urgent prior authorization and decision (days) | 1.17 day(s) | 0 day(s) |
| Time that elapsed between submission of urgent prior authorization and decision (days) | 1.69 day(s) | 1 day(s) |
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