Ambetter of Tennessee 2025 Authorization Data

Ambetter of Tennessee 2025 Authorization Data
Metric	Value
(1) The number of initial prior authorization requests that were approved or denied during the previous benefit plan year by the health carrier or utilization review organization	*64,398*
(2) The number of prior authorization requests that were appealed	*4,145*
(3) The number of appeals overturned and the number granted	*2,128 Overturned - 1,830 Upheld*
(4) The time between submission of an initial prior authorization request and response	*3 days*
(5) The top five (5) reasons for denial	1) Does not meet medical necessity criteria 2) Medical Necessity not evident 3) Does not meet medical necessity - no clinical records submitted 4) Alternate Procedure or LOC (Level of Care) 5) Additional Information Needed
(6) The average time between submission and response for an initial prior authorization request	3 days
(7) The average time between submission and response for an appeal of a prior authorization denial	*53 Days*