Retrospective Authorization Approval Rates by Payer and Drug Class
New CMS data reveals payer-by-payer prior authorization denial rates, though drugs remain excluded.
Renata Quisenberry
Senior Contributing Editor
Renata Quisenberry
Renata spent twelve years on the payer side as a medical policy analyst before crossing over to advise independent infusion centers on denial root-cause strategy and prior authorization workflows. She has consulted with more than 40 specialty practices across the Midwest and Southeast.
6 stories
Peer-to-Peer Review Request Process for Infusion Denials
A peer-to-peer call can overturn infusion denials faster than written appeals.
Renata Quisenberry
Medicare Advantage Prior Auth Burden in Infusion Settings
Denied infusion authorizations create solvency crises for practices treating chronic disease.
Renata Quisenberry
Mid-Cycle Authorization Lapses and Emergency Escalation Workflows
Practices that automate authorization tracking prevent costly mid-cycle denials before they happen.
Renata Quisenberry
Prior Auth Initiation Timelines for Recurring Biologic Infusions
Practices must start authorization weeks before infusion, not days.
Renata Quisenberry
How to Reopen and Recover a Confirmed Underpayment From a Commercial Payer
Pinpoint the exact contract rate, document every line, and file before the payer's window closes.
Renata Quisenberry