Clinical Services Team: Pharmacy Unit

% of pharmacy prior authorizations processed within 4 and 24 hours

100.0%Sep 2020

Line Bar
Notes on Methodology

Please note that in the chart above:

  • The dotted trendline represents the % of PA processed in 4 hours or less
  • The solid trendline represents the % of PA processed in 24 hours or less

​​​​​​​

 

Partners
  • Change Healthcare
Story Behind the Curve

This performance measure allows the Pharmacy Unit to monitor prior authorization (PA) processing turnaround times.  PA turn-around time is important to ensure that State and Federal Requirements are met by our vendor, Change Healthcare, in servicing our prescribers. In addition to monitoring the PA’s processed within 24 hours, the Pharmacy Unit decided to monitor how many PA’s were processed within 4 hours in consistently striving to make the process as efficient as possible providing less burden on our providers.

Last updated:  10/15/2020

Strategy

DVHA monitors weekly, the turnaround times for PA’s conducted by the CHC Help Desk. We also monitor staffing levels and asks for adjustments as need, such as vacation coverage, and anticipate changes that could impact call volumes such as operational claims processing changes. In addition, we work to reduce the number of PA’s needed through improving automated PA processing, and monitoring approval and denials rates for possible changes.

Scorecard Result Container Indicator Measure Action Actual Value Target Value Tag S R I P PM A m/d/yy m/d/yyyy