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
Section
Prior Auth Lifecycle
8 stories in Prior Auth Lifecycle.
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
Step Therapy Requirements and Override Strategies in Infusion Auth
Medicare Advantage step therapy now blocks many infusions unless cheaper drugs fail first.
Deshawn Okafor
Payer-Specific Prior Auth Requirements for Buy-and-Bill Biologics
Each payer's prior auth rules differ enough to tank reimbursement if you treat them as identical.
Deshawn Okafor
Auth Expiration Tracking Systems for Multi-Infusion Treatment Cycles
Tracking authorization windows prevents mid-cycle coverage gaps in infusion billing.
Marcus Thibeault
Prior Auth Initiation Timelines for Recurring Biologic Infusions
Practices that start prior auth when the appointment books lose weeks they could have used.
Renata Quisenberry