june 2015 outpatient authorization statistics service ... · – arkansas silver behavioral health...

47
Plan Description Product Event Reason Group Service Type Communication Channel Service Status - (LI) OP Event Status Reason - (LI) OP Level Of Urgency Number of Auths Market Place – Arkansas Bronze Other Medical Biopharmacy Phone APPROVE Pay Standard 1 Market Place – Arkansas Bronze Other Medical Biopharmacy Web APPROVE Pay Standard 1 Market Place – Arkansas Bronze Other Medical DME Phone APPROVE Pay Standard 1 Market Place – Arkansas Bronze Other Medical DME Fax PEND Special Instructions To Claims Standard 2 Market Place – Arkansas Bronze Other Medical DME Web APPROVE Pay Standard 1 Market Place – Arkansas Bronze Other Medical DME Web PEND Special Instructions To Claims Standard 1 Market Place – Arkansas Bronze Other Medical Home Health Phone APPROVE Pay Standard 5 Market Place – Arkansas Bronze Other Medical Home Health Phone APPROVE Special Instructions To Claims Standard 2 Market Place – Arkansas Bronze Other Medical Inpatient Services (S&P) Phone APPROVE Pay Retro 1 Market Place – Arkansas Bronze Other Medical Inpatient Services (S&P) Phone APPROVE Pay Concurrent 6 Market Place – Arkansas Bronze Other Medical Inpatient Services (S&P) Fax APPROVE Pay Retro 1 Ambetter of Arkansas June 2015 Outpatient Authorization Statistics

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Page 1: June 2015 Outpatient Authorization Statistics Service ... · – Arkansas Silver Behavioral Health BH PHP Phone APPROVE Event status reason not indicated in source. Concurrent 1 Market

Plan

DescriptionProduct

Event

Reason

Group

Service TypeCommunication

Channel

Service

Status - (LI)

OP

Event Status

Reason - (LI)

OP

Level Of

Urgency

Number

of Auths

Market Place

– ArkansasBronze

Other

MedicalBiopharmacy Phone APPROVE Pay Standard 1

Market Place

– ArkansasBronze

Other

MedicalBiopharmacy Web APPROVE Pay Standard 1

Market Place

– ArkansasBronze

Other

MedicalDME Phone APPROVE Pay Standard 1

Market Place

– ArkansasBronze

Other

MedicalDME Fax PEND

Special

Instructions

To Claims

Standard 2

Market Place

– ArkansasBronze

Other

MedicalDME Web APPROVE Pay Standard 1

Market Place

– ArkansasBronze

Other

MedicalDME Web PEND

Special

Instructions

To Claims

Standard 1

Market Place

– ArkansasBronze

Other

MedicalHome Health Phone APPROVE Pay Standard 5

Market Place

– ArkansasBronze

Other

MedicalHome Health Phone APPROVE

Special

Instructions

To Claims

Standard 2

Market Place

– ArkansasBronze

Other

Medical

Inpatient

Services (S&P)Phone APPROVE Pay Retro 1

Market Place

– ArkansasBronze

Other

Medical

Inpatient

Services (S&P)Phone APPROVE Pay Concurrent 6

Market Place

– ArkansasBronze

Other

Medical

Inpatient

Services (S&P)Fax APPROVE Pay Retro 1

Ambetter of Arkansas

June 2015 Outpatient Authorization Statistics

Page 2: June 2015 Outpatient Authorization Statistics Service ... · – Arkansas Silver Behavioral Health BH PHP Phone APPROVE Event status reason not indicated in source. Concurrent 1 Market

Market Place

– ArkansasBronze

Other

Medical

Inpatient

Services (S&P)Fax APPROVE Pay Concurrent 1

Market Place

– ArkansasBronze

Other

Medical

Inpatient

Services (S&P)Web APPROVE Pay Standard 1

Market Place

– ArkansasBronze

Other

Medical

Inpatient

Services (S&P)Web APPROVE Pay Concurrent 4

Market Place

– ArkansasBronze

Other

MedicalObservation Phone APPROVE Pay Retro 1

Market Place

– ArkansasBronze

Other

MedicalObservation Phone APPROVE Pay Standard 1

Market Place

– ArkansasBronze

Other

MedicalObservation Phone APPROVE Pay Concurrent 1

Market Place

– ArkansasBronze

Other

Medical

Outpatient

SurgeryPhone APPROVE Pay Standard 2

Market Place

– ArkansasBronze

Other

MedicalSleep Study Phone APPROVE Pay

Level of

Urgency not

indicated in

source.

2

Market Place

– ArkansasBronze

Other

MedicalSleep Study Phone APPROVE Pay Standard 3

Market Place

– ArkansasBronze

Other

MedicalOB Ultrasound Fax APPROVE Pay Standard 1

Market Place

– ArkansasBronze

Other

Medical

Hyperbaric

Oxygen

Therapy

Phone APPROVE Pay Standard 1

Market Place

– ArkansasGold

Other

Medical

Inpatient

Services (S&P)Phone APPROVE Pay Concurrent 1

Market Place

– ArkansasGold

Other

Medical

Inpatient

Services (S&P)Web APPROVE Pay Standard 1

Market Place

– ArkansasGold

Other

Medical

Inpatient

Services (S&P)Web APPROVE Pay Concurrent 2

Page 3: June 2015 Outpatient Authorization Statistics Service ... · – Arkansas Silver Behavioral Health BH PHP Phone APPROVE Event status reason not indicated in source. Concurrent 1 Market

Market Place

– ArkansasGold

Other

MedicalObservation Fax APPROVE Pay Retro 1

Market Place

– ArkansasGold

Other

MedicalVendor Fax DENY Admin Denial Standard 1

Market Place

– ArkansasGold

Other

MedicalOB Ultrasound Web APPROVE Pay Retro 1

Market Place

– Arkansas

Missing

Product

Group

Other

MedicalBiopharmacy Phone

Event status

reason not

indicated in

source.

Standard 1

Market Place

– Arkansas

Missing

Product

Group

Other

MedicalBiopharmacy Fax DENY

Denied by

Medical

Services

Level of

Urgency not

indicated in

source.

1

Market Place

– Arkansas

Missing

Product

Group

Other

MedicalBiopharmacy Web APPROVE Pay Standard 2

Market Place

– Arkansas

Missing

Product

Group

Other

MedicalDME Phone

Event status

reason not

indicated in

source.

Standard 2

Market Place

– Arkansas

Missing

Product

Group

Other

MedicalDME Phone APPROVE Pay Standard 1

Market Place

– Arkansas

Missing

Product

Group

Other

MedicalDME Web APPROVE Pay

Level of

Urgency not

indicated in

source.

1

Market Place

– Arkansas

Missing

Product

Group

Other

MedicalDME Web APPROVE Pay Urgent 1

Market Place

– Arkansas

Missing

Product

Group

Other

MedicalDME Web APPROVE Pay Standard 2

Market Place

– Arkansas

Missing

Product

Group

Other

Medical

Genetic

Testing &

Counseling

Email APPROVE Pay Retro 1

Market Place

– Arkansas

Missing

Product

Group

Other

MedicalHome Health Phone APPROVE Pay Standard 1

Market Place

– Arkansas

Missing

Product

Group

Other

MedicalHome Health Phone APPROVE Pay Concurrent 3

Page 4: June 2015 Outpatient Authorization Statistics Service ... · – Arkansas Silver Behavioral Health BH PHP Phone APPROVE Event status reason not indicated in source. Concurrent 1 Market

Market Place

– Arkansas

Missing

Product

Group

Other

MedicalHome Health Fax

Event status

reason not

indicated in

source.

Retro 1

Market Place

– Arkansas

Missing

Product

Group

Other

MedicalHome Health Fax APPROVE Pay Retro 1

Market Place

– Arkansas

Missing

Product

Group

Other

Medical

Inpatient

Services (S&P)Phone APPROVE Pay Retro 1

Market Place

– Arkansas

Missing

Product

Group

Other

Medical

Inpatient

Services (S&P)Phone APPROVE Pay Standard 4

Market Place

– Arkansas

Missing

Product

Group

Other

Medical

Inpatient

Services (S&P)Phone APPROVE Pay Concurrent 14

Market Place

– Arkansas

Missing

Product

Group

Other

Medical

Inpatient

Services (S&P)Fax APPROVE Pay Retro 1

Market Place

– Arkansas

Missing

Product

Group

Other

Medical

Inpatient

Services (S&P)Web APPROVE Pay Urgent 1

Market Place

– Arkansas

Missing

Product

Group

Other

Medical

Inpatient

Services (S&P)Web APPROVE Pay Retro 1

Market Place

– Arkansas

Missing

Product

Group

Other

Medical

Inpatient

Services (S&P)Web APPROVE Pay Standard 1

Market Place

– Arkansas

Missing

Product

Group

Other

Medical

Inpatient

Services (S&P)Web APPROVE Pay Concurrent 11

Market Place

– Arkansas

Missing

Product

Group

Other

MedicalObservation Web APPROVE Pay

Level of

Urgency not

indicated in

source.

1

Market Place

– Arkansas

Missing

Product

Group

Other

Medical

Pain

ManagementPhone

Event status

reason not

indicated in

source.

Standard 1

Market Place

– Arkansas

Missing

Product

Group

Other

Medical

Pain

ManagementWeb

Event status

reason not

indicated in

source.

Standard 3

Market Place

– Arkansas

Missing

Product

Group

Other

MedicalSleep Study Phone

Event status

reason not

indicated in

source.

Standard 4

Page 5: June 2015 Outpatient Authorization Statistics Service ... · – Arkansas Silver Behavioral Health BH PHP Phone APPROVE Event status reason not indicated in source. Concurrent 1 Market

Market Place

– Arkansas

Missing

Product

Group

Other

MedicalSleep Study Phone APPROVE Pay Standard 2

Market Place

– Arkansas

Missing

Product

Group

Other

MedicalSleep Study Web APPROVE Pay Standard 4

Market Place

– Arkansas

Missing

Product

Group

Other

MedicalOrthotics Web

Event status

reason not

indicated in

source.

Standard 2

Market Place

– Arkansas

Missing

Product

Group

Other

MedicalOrthotics Web APPROVE Pay Standard 1

Market Place

– Arkansas

Missing

Product

Group

Other

MedicalProsthetics Web

Event status

reason not

indicated in

source.

Standard 4

Market Place

– Arkansas

Missing

Product

Group

Other

MedicalDrug Testing Fax APPROVE Pay Standard 6

Market Place

– Arkansas

Missing

Product

Group

Other

MedicalDrug Testing Web

Event status

reason not

indicated in

source.

Standard 2

Market Place

– Arkansas

Missing

Product

Group

Other

MedicalDrug Testing Web APPROVE Pay Standard 13

Market Place

– Arkansas

Missing

Product

Group

Other

MedicalOB Ultrasound Web

Event status

reason not

indicated in

source.

Standard 1

Market Place

– ArkansasSilver

Behavioral

HealthBH PHP Phone APPROVE

Event status

reason not

indicated in

source.

Concurrent 1

Market Place

– ArkansasSilver

Behavioral

HealthBH PHP Phone APPROVE Pay

Level of

Urgency not

indicated in

source.

4

Market Place

– ArkansasSilver

Behavioral

HealthBH PHP Phone APPROVE Pay Standard 5

Market Place

– ArkansasSilver

Behavioral

HealthBH PHP Phone APPROVE Pay Concurrent 95

Market Place

– ArkansasSilver

Behavioral

HealthBH PHP Phone APPROVE Pay on Appeal Concurrent 1

Page 6: June 2015 Outpatient Authorization Statistics Service ... · – Arkansas Silver Behavioral Health BH PHP Phone APPROVE Event status reason not indicated in source. Concurrent 1 Market

Market Place

– ArkansasSilver

Behavioral

HealthBH PHP Phone DENY

Denied by

Medical

Services

Concurrent 5

Market Place

– ArkansasSilver

Behavioral

HealthBH PHP Phone DENY Admin Denial Concurrent 1

Market Place

– ArkansasSilver

Behavioral

HealthBH PHP Phone PEND

Special

Instructions

To Claims

Concurrent 1

Market Place

– ArkansasSilver

Behavioral

HealthBH PHP Phone PEND Under Review Concurrent 1

Market Place

– ArkansasSilver

Behavioral

HealthBH PHP Fax APPROVE Pay Concurrent 3

Market Place

– ArkansasSilver

Behavioral

HealthMH/CD OBS Fax APPROVE Pay Retro 1

Market Place

– ArkansasSilver

Other

MedicalBiopharmacy Phone

Event status

reason not

indicated in

source.

Standard 1

Market Place

– ArkansasSilver

Other

MedicalBiopharmacy Phone APPROVE

Event status

reason not

indicated in

source.

Level of

Urgency not

indicated in

source.

1

Market Place

– ArkansasSilver

Other

MedicalBiopharmacy Phone APPROVE Pay

Level of

Urgency not

indicated in

source.

1

Market Place

– ArkansasSilver

Other

MedicalBiopharmacy Phone APPROVE Pay Urgent 7

Market Place

– ArkansasSilver

Other

MedicalBiopharmacy Phone APPROVE Pay Retro 6

Market Place

– ArkansasSilver

Other

MedicalBiopharmacy Phone APPROVE Pay Standard 140

Market Place

– ArkansasSilver

Other

MedicalBiopharmacy Phone APPROVE Pay Concurrent 2

Market Place

– ArkansasSilver

Other

MedicalBiopharmacy Phone APPROVE

Special

Instructions

To Claims

Standard 1

Page 7: June 2015 Outpatient Authorization Statistics Service ... · – Arkansas Silver Behavioral Health BH PHP Phone APPROVE Event status reason not indicated in source. Concurrent 1 Market

Market Place

– ArkansasSilver

Other

MedicalBiopharmacy Phone DENY

Denied by

Medical

Services

Standard 20

Market Place

– ArkansasSilver

Other

MedicalBiopharmacy Phone DENY Admin Denial Standard 2

Market Place

– ArkansasSilver

Other

MedicalBiopharmacy Phone PEND Pay Standard 1

Market Place

– ArkansasSilver

Other

MedicalBiopharmacy Fax APPROVE Pay Retro 1

Market Place

– ArkansasSilver

Other

MedicalBiopharmacy Fax APPROVE Pay Standard 33

Market Place

– ArkansasSilver

Other

MedicalBiopharmacy Fax APPROVE Pay Concurrent 1

Market Place

– ArkansasSilver

Other

MedicalBiopharmacy Fax APPROVE Pay on Appeal Standard 1

Market Place

– ArkansasSilver

Other

MedicalBiopharmacy Fax APPROVE

Special

Instructions

To Claims

Standard 1

Market Place

– ArkansasSilver

Other

MedicalBiopharmacy Fax DENY

Denied by

Medical

Services

Standard 1

Market Place

– ArkansasSilver

Other

MedicalBiopharmacy Fax DENY Admin Denial Standard 1

Market Place

– ArkansasSilver

Other

MedicalBiopharmacy Web

Event status

reason not

indicated in

source.

Standard 1

Market Place

– ArkansasSilver

Other

MedicalBiopharmacy Web APPROVE Pay Urgent 5

Market Place

– ArkansasSilver

Other

MedicalBiopharmacy Web APPROVE Pay Standard 95

Market Place

– ArkansasSilver

Other

MedicalBiopharmacy Web APPROVE Pay Concurrent 1

Page 8: June 2015 Outpatient Authorization Statistics Service ... · – Arkansas Silver Behavioral Health BH PHP Phone APPROVE Event status reason not indicated in source. Concurrent 1 Market

Market Place

– ArkansasSilver

Other

MedicalBiopharmacy Web APPROVE

Denied by

Medical

Services

Standard 1

Market Place

– ArkansasSilver

Other

MedicalBiopharmacy Web DENY Pay Standard 1

Market Place

– ArkansasSilver

Other

MedicalBiopharmacy Web DENY

Denied by

Medical

Services

Urgent 1

Market Place

– ArkansasSilver

Other

MedicalBiopharmacy Web DENY

Denied by

Medical

Services

Standard 11

Market Place

– ArkansasSilver

Other

MedicalBiopharmacy Other APPROVE Pay Retro 1

Market Place

– ArkansasSilver

Other

MedicalBiopharmacy Email APPROVE Pay Retro 1

Market Place

– ArkansasSilver

Other

MedicalBiopharmacy Email APPROVE Pay Standard 1

Market Place

– ArkansasSilver

Other

MedicalTransplant Phone APPROVE Pay Retro 2

Market Place

– ArkansasSilver

Other

MedicalTransplant Fax APPROVE Pay

Level of

Urgency not

indicated in

source.

4

Market Place

– ArkansasSilver

Other

MedicalTransplant Fax APPROVE Pay Standard 17

Market Place

– ArkansasSilver

Other

MedicalTransplant Fax DENY

Denied by

Medical

Services

Standard 8

Market Place

– ArkansasSilver

Other

MedicalTransplant Fax PEND

Special

Instructions

To Claims

Standard 7

Market Place

– ArkansasSilver

Other

MedicalTransplant Fax PEND Under Review Standard 1

Market Place

– ArkansasSilver

Other

MedicalDME

Communication

channel given in

source but not

found in

APPROVE Pay Standard 1

Page 9: June 2015 Outpatient Authorization Statistics Service ... · – Arkansas Silver Behavioral Health BH PHP Phone APPROVE Event status reason not indicated in source. Concurrent 1 Market

Market Place

– ArkansasSilver

Other

MedicalDME Phone

Event status

reason not

indicated in

source.

Urgent 1

Market Place

– ArkansasSilver

Other

MedicalDME Phone

Event status

reason not

indicated in

source.

Standard 7

Market Place

– ArkansasSilver

Other

MedicalDME Phone APPROVE

Event status

reason not

indicated in

source.

Level of

Urgency not

indicated in

source.

1

Market Place

– ArkansasSilver

Other

MedicalDME Phone APPROVE Pay

Level of

Urgency not

indicated in

source.

3

Market Place

– ArkansasSilver

Other

MedicalDME Phone APPROVE Pay Urgent 10

Market Place

– ArkansasSilver

Other

MedicalDME Phone APPROVE Pay Retro 12

Market Place

– ArkansasSilver

Other

MedicalDME Phone APPROVE Pay Standard 458

Market Place

– ArkansasSilver

Other

MedicalDME Phone APPROVE Pay Concurrent 17

Market Place

– ArkansasSilver

Other

MedicalDME Phone APPROVE

Special

Instructions

To Claims

Urgent 1

Market Place

– ArkansasSilver

Other

MedicalDME Phone APPROVE

Special

Instructions

To Claims

Standard 2

Market Place

– ArkansasSilver

Other

MedicalDME Phone APPROVE

Denied by

Medical

Services

Standard 1

Market Place

– ArkansasSilver

Other

MedicalDME Phone APPROVE

Denial Upheld

on AppealStandard 1

Market Place

– ArkansasSilver

Other

MedicalDME Phone DENY Pay Standard 1

Market Place

– ArkansasSilver

Other

MedicalDME Phone DENY

Denied by

Medical

Services

Level of

Urgency not

indicated in

source.

1

Page 10: June 2015 Outpatient Authorization Statistics Service ... · – Arkansas Silver Behavioral Health BH PHP Phone APPROVE Event status reason not indicated in source. Concurrent 1 Market

Market Place

– ArkansasSilver

Other

MedicalDME Phone DENY

Denied by

Medical

Services

Retro 1

Market Place

– ArkansasSilver

Other

MedicalDME Phone DENY

Denied by

Medical

Services

Standard 39

Market Place

– ArkansasSilver

Other

MedicalDME Phone DENY

Denied by

Medical

Services

Concurrent 2

Market Place

– ArkansasSilver

Other

MedicalDME Phone DENY

Denial Upheld

on AppealStandard 1

Market Place

– ArkansasSilver

Other

MedicalDME Phone DENY Admin Denial Standard 3

Market Place

– ArkansasSilver

Other

MedicalDME Phone DENY Admin Denial Concurrent 1

Market Place

– ArkansasSilver

Other

MedicalDME Phone PEND

Event status

reason not

indicated in

source.

Standard 1

Market Place

– ArkansasSilver

Other

MedicalDME Phone PEND Pay Standard 6

Market Place

– ArkansasSilver

Other

MedicalDME Phone PEND

Special

Instructions

To Claims

Urgent 2

Market Place

– ArkansasSilver

Other

MedicalDME Phone PEND

Special

Instructions

To Claims

Standard 84

Market Place

– ArkansasSilver

Other

MedicalDME Phone PEND

Special

Instructions

To Claims

Concurrent 2

Market Place

– ArkansasSilver

Other

MedicalDME Fax

Event status

reason not

indicated in

source.

Retro 1

Market Place

– ArkansasSilver

Other

MedicalDME Fax

Event status

reason not

indicated in

source.

Standard 1

Market Place

– ArkansasSilver

Other

MedicalDME Fax APPROVE

Event status

reason not

indicated in

source.

Level of

Urgency not

indicated in

source.

1

Page 11: June 2015 Outpatient Authorization Statistics Service ... · – Arkansas Silver Behavioral Health BH PHP Phone APPROVE Event status reason not indicated in source. Concurrent 1 Market

Market Place

– ArkansasSilver

Other

MedicalDME Fax APPROVE Pay

Level of

Urgency not

indicated in

source.

3

Market Place

– ArkansasSilver

Other

MedicalDME Fax APPROVE Pay Urgent 1

Market Place

– ArkansasSilver

Other

MedicalDME Fax APPROVE Pay Retro 8

Market Place

– ArkansasSilver

Other

MedicalDME Fax APPROVE Pay Standard 159

Market Place

– ArkansasSilver

Other

MedicalDME Fax APPROVE Pay Stabilization 2

Market Place

– ArkansasSilver

Other

MedicalDME Fax APPROVE Pay Concurrent 13

Market Place

– ArkansasSilver

Other

MedicalDME Fax APPROVE

Special

Instructions

To Claims

Standard 3

Market Place

– ArkansasSilver

Other

MedicalDME Fax DENY

Denied by

Medical

Services

Standard 7

Market Place

– ArkansasSilver

Other

MedicalDME Fax DENY Admin Denial Standard 2

Market Place

– ArkansasSilver

Other

MedicalDME Fax DENY Admin Denial Concurrent 1

Market Place

– ArkansasSilver

Other

MedicalDME Fax PEND Pay Standard 3

Market Place

– ArkansasSilver

Other

MedicalDME Fax PEND Pay Stabilization 1

Market Place

– ArkansasSilver

Other

MedicalDME Fax PEND

Special

Instructions

To Claims

Retro 1

Market Place

– ArkansasSilver

Other

MedicalDME Fax PEND

Special

Instructions

To Claims

Standard 41

Page 12: June 2015 Outpatient Authorization Statistics Service ... · – Arkansas Silver Behavioral Health BH PHP Phone APPROVE Event status reason not indicated in source. Concurrent 1 Market

Market Place

– ArkansasSilver

Other

MedicalDME Web

Event status

reason not

indicated in

source.

Standard 3

Market Place

– ArkansasSilver

Other

MedicalDME Web APPROVE

Event status

reason not

indicated in

source.

Level of

Urgency not

indicated in

source.

1

Market Place

– ArkansasSilver

Other

MedicalDME Web APPROVE Pay

Level of

Urgency not

indicated in

source.

2

Market Place

– ArkansasSilver

Other

MedicalDME Web APPROVE Pay Urgent 17

Market Place

– ArkansasSilver

Other

MedicalDME Web APPROVE Pay Standard 486

Market Place

– ArkansasSilver

Other

MedicalDME Web APPROVE Pay Concurrent 6

Market Place

– ArkansasSilver

Other

MedicalDME Web APPROVE

Special

Instructions

To Claims

Standard 2

Market Place

– ArkansasSilver

Other

MedicalDME Web APPROVE

Denial Upheld

on AppealStandard 1

Market Place

– ArkansasSilver

Other

MedicalDME Web DENY

Denied by

Medical

Services

Urgent 1

Market Place

– ArkansasSilver

Other

MedicalDME Web DENY

Denied by

Medical

Services

Retro 1

Market Place

– ArkansasSilver

Other

MedicalDME Web DENY

Denied by

Medical

Services

Standard 32

Market Place

– ArkansasSilver

Other

MedicalDME Web DENY

Denied by

Medical

Services

Concurrent 1

Market Place

– ArkansasSilver

Other

MedicalDME Web DENY Admin Denial Standard 3

Market Place

– ArkansasSilver

Other

MedicalDME Web PEND Pay Standard 7

Page 13: June 2015 Outpatient Authorization Statistics Service ... · – Arkansas Silver Behavioral Health BH PHP Phone APPROVE Event status reason not indicated in source. Concurrent 1 Market

Market Place

– ArkansasSilver

Other

MedicalDME Web PEND

Special

Instructions

To Claims

Urgent 3

Market Place

– ArkansasSilver

Other

MedicalDME Web PEND

Special

Instructions

To Claims

Retro 1

Market Place

– ArkansasSilver

Other

MedicalDME Web PEND

Special

Instructions

To Claims

Standard 108

Market Place

– ArkansasSilver

Other

MedicalDME Web PEND

Avoidable

ReadmissionStandard 1

Market Place

– ArkansasSilver

Other

MedicalDME Other APPROVE Pay Retro 2

Market Place

– ArkansasSilver

Other

MedicalDME CDMS-Fax APPROVE Pay Standard 13

Market Place

– ArkansasSilver

Other

MedicalDME CDMS-Fax DENY

Denied by

Medical

Services

Standard 1

Market Place

– ArkansasSilver

Other

MedicalDME CDMS-Fax PEND

Special

Instructions

To Claims

Standard 1

Market Place

– ArkansasSilver

Other

MedicalDME Email APPROVE Pay Retro 3

Market Place

– ArkansasSilver

Other

MedicalDME Email APPROVE Pay Standard 1

Market Place

– ArkansasSilver

Other

MedicalDME Email PEND

Special

Instructions

To Claims

Standard 1

Market Place

– ArkansasSilver

Other

Medical

Genetic

Testing &

Counseling

Phone

Event status

reason not

indicated in

source.

Standard 2

Market Place

– ArkansasSilver

Other

Medical

Genetic

Testing &

Counseling

Phone APPROVE Pay Standard 7

Market Place

– ArkansasSilver

Other

Medical

Genetic

Testing &

Counseling

Phone APPROVE Pay Concurrent 1

Page 14: June 2015 Outpatient Authorization Statistics Service ... · – Arkansas Silver Behavioral Health BH PHP Phone APPROVE Event status reason not indicated in source. Concurrent 1 Market

Market Place

– ArkansasSilver

Other

Medical

Genetic

Testing &

Counseling

Phone APPROVE

Denied by

Medical

Services

Standard 1

Market Place

– ArkansasSilver

Other

Medical

Genetic

Testing &

Counseling

Phone DENY

Denied by

Medical

Services

Standard 5

Market Place

– ArkansasSilver

Other

Medical

Genetic

Testing &

Counseling

Phone DENY Admin Denial Standard 1

Market Place

– ArkansasSilver

Other

Medical

Genetic

Testing &

Counseling

Phone PEND Pay Standard 2

Market Place

– ArkansasSilver

Other

Medical

Genetic

Testing &

Counseling

Phone PEND

Special

Instructions

To Claims

Concurrent 1

Market Place

– ArkansasSilver

Other

Medical

Genetic

Testing &

Counseling

Fax APPROVE Pay Retro 2

Market Place

– ArkansasSilver

Other

Medical

Genetic

Testing &

Counseling

Fax APPROVE Pay Standard 19

Market Place

– ArkansasSilver

Other

Medical

Genetic

Testing &

Counseling

Fax APPROVE Under Review Standard 1

Market Place

– ArkansasSilver

Other

Medical

Genetic

Testing &

Counseling

Fax DENY

Denied by

Medical

Services

Standard 5

Market Place

– ArkansasSilver

Other

Medical

Genetic

Testing &

Counseling

Fax DENY

Denied by

Medical

Services

Stabilization 1

Market Place

– ArkansasSilver

Other

Medical

Genetic

Testing &

Counseling

Fax PEND

Special

Instructions

To Claims

Retro 1

Market Place

– ArkansasSilver

Other

Medical

Genetic

Testing &

Counseling

Web APPROVE Pay Standard 5

Market Place

– ArkansasSilver

Other

Medical

Genetic

Testing &

Counseling

Web APPROVE Pay Concurrent 2

Market Place

– ArkansasSilver

Other

MedicalHome Health Phone

Event status

reason not

indicated in

source.

Standard 2

Page 15: June 2015 Outpatient Authorization Statistics Service ... · – Arkansas Silver Behavioral Health BH PHP Phone APPROVE Event status reason not indicated in source. Concurrent 1 Market

Market Place

– ArkansasSilver

Other

MedicalHome Health Phone APPROVE

Event status

reason not

indicated in

source.

Level of

Urgency not

indicated in

source.

7

Market Place

– ArkansasSilver

Other

MedicalHome Health Phone APPROVE Pay

Level of

Urgency not

indicated in

source.

12

Market Place

– ArkansasSilver

Other

MedicalHome Health Phone APPROVE Pay Urgent 3

Market Place

– ArkansasSilver

Other

MedicalHome Health Phone APPROVE Pay Retro 32

Market Place

– ArkansasSilver

Other

MedicalHome Health Phone APPROVE Pay Standard 722

Market Place

– ArkansasSilver

Other

MedicalHome Health Phone APPROVE Pay Stabilization 4

Market Place

– ArkansasSilver

Other

MedicalHome Health Phone APPROVE Pay Concurrent 120

Market Place

– ArkansasSilver

Other

MedicalHome Health Phone APPROVE

Pend-Partial

Approval on

Appeal

Standard 2

Market Place

– ArkansasSilver

Other

MedicalHome Health Phone APPROVE

Pend Partial

ApprovalRetro 1

Market Place

– ArkansasSilver

Other

MedicalHome Health Phone APPROVE

Pend Partial

ApprovalStandard 8

Market Place

– ArkansasSilver

Other

MedicalHome Health Phone APPROVE

Pend Partial

ApprovalStabilization 1

Market Place

– ArkansasSilver

Other

MedicalHome Health Phone APPROVE

Pend Partial

ApprovalConcurrent 1

Market Place

– ArkansasSilver

Other

MedicalHome Health Phone APPROVE

Special

Instructions

To Claims

Level of

Urgency not

indicated in

source.

1

Market Place

– ArkansasSilver

Other

MedicalHome Health Phone APPROVE

Special

Instructions

To Claims

Retro 2

Page 16: June 2015 Outpatient Authorization Statistics Service ... · – Arkansas Silver Behavioral Health BH PHP Phone APPROVE Event status reason not indicated in source. Concurrent 1 Market

Market Place

– ArkansasSilver

Other

MedicalHome Health Phone APPROVE

Special

Instructions

To Claims

Standard 22

Market Place

– ArkansasSilver

Other

MedicalHome Health Phone APPROVE

Special

Instructions

To Claims

Concurrent 4

Market Place

– ArkansasSilver

Other

MedicalHome Health Phone APPROVE

Denied by

Medical

Services

Standard 3

Market Place

– ArkansasSilver

Other

MedicalHome Health Phone APPROVE

Denied by

Medical

Services

Concurrent 1

Market Place

– ArkansasSilver

Other

MedicalHome Health Phone DENY Pay Retro 1

Market Place

– ArkansasSilver

Other

MedicalHome Health Phone DENY Pay Standard 15

Market Place

– ArkansasSilver

Other

MedicalHome Health Phone DENY Pay Concurrent 2

Market Place

– ArkansasSilver

Other

MedicalHome Health Phone DENY

Pend-Partial

Approval on

Appeal

Standard 2

Market Place

– ArkansasSilver

Other

MedicalHome Health Phone DENY

Pend Partial

ApprovalRetro 1

Market Place

– ArkansasSilver

Other

MedicalHome Health Phone DENY

Pend Partial

ApprovalStandard 8

Market Place

– ArkansasSilver

Other

MedicalHome Health Phone DENY

Pend Partial

ApprovalConcurrent 1

Market Place

– ArkansasSilver

Other

MedicalHome Health Phone DENY

Special

Instructions

To Claims

Standard 3

Market Place

– ArkansasSilver

Other

MedicalHome Health Phone DENY

Denied by

Medical

Services

Retro 1

Market Place

– ArkansasSilver

Other

MedicalHome Health Phone DENY

Denied by

Medical

Services

Standard 22

Page 17: June 2015 Outpatient Authorization Statistics Service ... · – Arkansas Silver Behavioral Health BH PHP Phone APPROVE Event status reason not indicated in source. Concurrent 1 Market

Market Place

– ArkansasSilver

Other

MedicalHome Health Phone DENY

Denied by

Medical

Services

Concurrent 4

Market Place

– ArkansasSilver

Other

MedicalHome Health Phone DENY Admin Denial Standard 4

Market Place

– ArkansasSilver

Other

MedicalHome Health Phone PEND Pay Standard 3

Market Place

– ArkansasSilver

Other

MedicalHome Health Phone PEND

Special

Instructions

To Claims

Level of

Urgency not

indicated in

source.

1

Market Place

– ArkansasSilver

Other

MedicalHome Health Phone PEND

Special

Instructions

To Claims

Standard 26

Market Place

– ArkansasSilver

Other

MedicalHome Health Phone PEND

Special

Instructions

To Claims

Concurrent 4

Market Place

– ArkansasSilver

Other

MedicalHome Health Fax

Event status

reason not

indicated in

source.

Standard 1

Market Place

– ArkansasSilver

Other

MedicalHome Health Fax APPROVE Pay Retro 6

Market Place

– ArkansasSilver

Other

MedicalHome Health Fax APPROVE Pay Standard 26

Market Place

– ArkansasSilver

Other

MedicalHome Health Fax APPROVE Pay Concurrent 31

Market Place

– ArkansasSilver

Other

MedicalHome Health Fax APPROVE

Special

Instructions

To Claims

Standard 2

Market Place

– ArkansasSilver

Other

MedicalHome Health Fax APPROVE

Denied by

Medical

Services

Concurrent 2

Market Place

– ArkansasSilver

Other

MedicalHome Health Fax DENY Pay Concurrent 2

Market Place

– ArkansasSilver

Other

MedicalHome Health Fax DENY

Denied by

Medical

Services

Standard 1

Page 18: June 2015 Outpatient Authorization Statistics Service ... · – Arkansas Silver Behavioral Health BH PHP Phone APPROVE Event status reason not indicated in source. Concurrent 1 Market

Market Place

– ArkansasSilver

Other

MedicalHome Health Fax DENY

Denied by

Medical

Services

Concurrent 3

Market Place

– ArkansasSilver

Other

MedicalHome Health Fax DENY Admin Denial Retro 1

Market Place

– ArkansasSilver

Other

MedicalHome Health Fax DENY Admin Denial Concurrent 1

Market Place

– ArkansasSilver

Other

MedicalHome Health Fax PEND

Special

Instructions

To Claims

Standard 5

Market Place

– ArkansasSilver

Other

MedicalHome Health Fax PEND

Special

Instructions

To Claims

Concurrent 2

Market Place

– ArkansasSilver

Other

MedicalHome Health Web APPROVE Pay Urgent 1

Market Place

– ArkansasSilver

Other

MedicalHome Health Web APPROVE Pay Retro 6

Market Place

– ArkansasSilver

Other

MedicalHome Health Web APPROVE Pay Standard 46

Market Place

– ArkansasSilver

Other

MedicalHome Health Web APPROVE Pay Concurrent 1

Market Place

– ArkansasSilver

Other

MedicalHome Health Web APPROVE

Pend Partial

ApprovalStandard 1

Market Place

– ArkansasSilver

Other

MedicalHome Health Web DENY Pay Standard 3

Market Place

– ArkansasSilver

Other

MedicalHome Health Web DENY

Denied by

Medical

Services

Standard 1

Market Place

– ArkansasSilver

Other

MedicalHome Health Web PEND

Event status

reason not

indicated in

source.

Standard 1

Market Place

– ArkansasSilver

Other

MedicalHome Health Web PEND

Pend Partial

ApprovalStandard 1

Page 19: June 2015 Outpatient Authorization Statistics Service ... · – Arkansas Silver Behavioral Health BH PHP Phone APPROVE Event status reason not indicated in source. Concurrent 1 Market

Market Place

– ArkansasSilver

Other

MedicalHome Health Web PEND

Special

Instructions

To Claims

Standard 6

Market Place

– ArkansasSilver

Other

MedicalHome Health Other APPROVE Pay Retro 1

Market Place

– ArkansasSilver

Other

MedicalHome Health CDMS-Fax APPROVE Pay Standard 21

Market Place

– ArkansasSilver

Other

MedicalHome Health CDMS-Fax DENY Pay Standard 1

Market Place

– ArkansasSilver

Other

MedicalHome Health CDMS-Fax DENY

Denied by

Medical

Services

Standard 1

Market Place

– ArkansasSilver

Other

MedicalHome Health Email APPROVE Pay Retro 1

Market Place

– ArkansasSilver

Other

MedicalHospice Phone APPROVE Pay

Level of

Urgency not

indicated in

source.

1

Market Place

– ArkansasSilver

Other

MedicalHospice Phone APPROVE Pay Retro 4

Market Place

– ArkansasSilver

Other

MedicalHospice Phone APPROVE Pay Standard 5

Market Place

– ArkansasSilver

Other

MedicalHospice Phone APPROVE Pay Concurrent 11

Market Place

– ArkansasSilver

Other

MedicalHospice Phone APPROVE

Special

Instructions

To Claims

Retro 1

Market Place

– ArkansasSilver

Other

MedicalHospice Fax APPROVE Pay Concurrent 1

Market Place

– ArkansasSilver

Other

MedicalHospice Web APPROVE Pay Standard 1

Market Place

– ArkansasSilver

Other

MedicalHospice Other APPROVE Pay Retro 1

Page 20: June 2015 Outpatient Authorization Statistics Service ... · – Arkansas Silver Behavioral Health BH PHP Phone APPROVE Event status reason not indicated in source. Concurrent 1 Market

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Phone

Event status

reason not

indicated in

source.

Concurrent 2

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Phone APPROVE

Event status

reason not

indicated in

source.

Level of

Urgency not

indicated in

source.

6

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Phone APPROVE

Event status

reason not

indicated in

source.

Retro 1

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Phone APPROVE Pay

Level of

Urgency not

indicated in

source.

17

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Phone APPROVE Pay Urgent 8

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Phone APPROVE Pay Retro 139

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Phone APPROVE Pay Standard 547

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Phone APPROVE Pay Stabilization 2

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Phone APPROVE Pay Concurrent 1,405

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Phone APPROVE Pay on Appeal Concurrent 2

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Phone APPROVE

Pend Partial

ApprovalStandard 1

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Phone APPROVE

Pend Partial

ApprovalConcurrent 2

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Phone APPROVE

Special

Instructions

To Claims

Concurrent 1

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Phone APPROVE

Denied by

Medical

Services

Concurrent 3

Page 21: June 2015 Outpatient Authorization Statistics Service ... · – Arkansas Silver Behavioral Health BH PHP Phone APPROVE Event status reason not indicated in source. Concurrent 1 Market

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Phone APPROVE Under Review Standard 1

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Phone DENY

Event status

reason not

indicated in

source.

Level of

Urgency not

indicated in

source.

1

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Phone DENY Pay Retro 2

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Phone DENY Pay Standard 3

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Phone DENY Pay Concurrent 12

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Phone DENY

Pend Partial

ApprovalStandard 1

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Phone DENY

Pend Partial

ApprovalConcurrent 2

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Phone DENY

Special

Instructions

To Claims

Retro 1

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Phone DENY

Denied by

Medical

Services

Urgent 1

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Phone DENY

Denied by

Medical

Services

Retro 5

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Phone DENY

Denied by

Medical

Services

Expedited 1

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Phone DENY

Denied by

Medical

Services

Standard 26

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Phone DENY

Denied by

Medical

Services

Concurrent 39

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Phone DENY

Denial Upheld

on AppealStandard 1

Page 22: June 2015 Outpatient Authorization Statistics Service ... · – Arkansas Silver Behavioral Health BH PHP Phone APPROVE Event status reason not indicated in source. Concurrent 1 Market

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Phone DENY

Denial Upheld

on AppealConcurrent 1

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Phone DENY Admin Denial Standard 2

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Phone DENY Admin Denial Concurrent 4

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Phone PEND Pay

Level of

Urgency not

indicated in

source.

1

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Phone PEND Pay Retro 1

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Phone PEND Pay Standard 3

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Phone PEND Pay Concurrent 12

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Phone PEND

Special

Instructions

To Claims

Concurrent 1

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Phone PEND

Avoidable

ReadmissionStandard 1

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Fax APPROVE Pay

Level of

Urgency not

indicated in

source.

2

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Fax APPROVE Pay Urgent 6

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Fax APPROVE Pay Retro 76

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Fax APPROVE Pay Standard 57

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Fax APPROVE Pay Concurrent 206

Page 23: June 2015 Outpatient Authorization Statistics Service ... · – Arkansas Silver Behavioral Health BH PHP Phone APPROVE Event status reason not indicated in source. Concurrent 1 Market

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Fax DENY Pay Urgent 1

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Fax DENY Pay Standard 1

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Fax DENY Pay Concurrent 2

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Fax DENY

Denied by

Medical

Services

Standard 4

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Fax DENY

Denied by

Medical

Services

Concurrent 8

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Fax DENY Admin Denial Retro 2

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Fax DENY Admin Denial Standard 1

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Fax PEND Pay Concurrent 3

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Fax PEND

Special

Instructions

To Claims

Concurrent 1

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Mail APPROVE Pay Retro 4

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Mail APPROVE Pay Concurrent 3

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Mail APPROVE Pay on Appeal Retro 6

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Web

Event status

reason not

indicated in

source.

Retro 1

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Web APPROVE

Event status

reason not

indicated in

source.

Level of

Urgency not

indicated in

source.

1

Page 24: June 2015 Outpatient Authorization Statistics Service ... · – Arkansas Silver Behavioral Health BH PHP Phone APPROVE Event status reason not indicated in source. Concurrent 1 Market

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Web APPROVE Pay

Level of

Urgency not

indicated in

source.

14

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Web APPROVE Pay Urgent 32

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Web APPROVE Pay Non-Urgent 2

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Web APPROVE Pay Retro 42

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Web APPROVE Pay Standard 344

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Web APPROVE Pay Stabilization 3

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Web APPROVE Pay Concurrent 767

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Web APPROVE Pay on Appeal Standard 1

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Web APPROVE Pay on Appeal Concurrent 2

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Web APPROVE

Pend Partial

ApprovalConcurrent 2

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Web APPROVE

Special

Instructions

To Claims

Standard 2

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Web APPROVE

Special

Instructions

To Claims

Concurrent 2

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Web APPROVE

Denied by

Medical

Services

Concurrent 3

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Web DENY Pay Concurrent 4

Page 25: June 2015 Outpatient Authorization Statistics Service ... · – Arkansas Silver Behavioral Health BH PHP Phone APPROVE Event status reason not indicated in source. Concurrent 1 Market

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Web DENY

Pend Partial

ApprovalConcurrent 2

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Web DENY

Special

Instructions

To Claims

Concurrent 2

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Web DENY

Denied by

Medical

Services

Retro 1

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Web DENY

Denied by

Medical

Services

Standard 5

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Web DENY

Denied by

Medical

Services

Concurrent 17

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Web DENY Admin Denial Retro 1

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Web DENY Admin Denial Standard 1

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Web DENY Admin Denial Concurrent 3

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Web PEND Pay Standard 6

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Web PEND Pay Concurrent 10

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Web PEND

Pend Partial

ApprovalConcurrent 1

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Web PEND

Special

Instructions

To Claims

Standard 1

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Web PEND

Special

Instructions

To Claims

Concurrent 1

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Other

Event status

reason not

indicated in

source.

Retro 3

Page 26: June 2015 Outpatient Authorization Statistics Service ... · – Arkansas Silver Behavioral Health BH PHP Phone APPROVE Event status reason not indicated in source. Concurrent 1 Market

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Other APPROVE Pay Retro 32

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Other APPROVE Pay Concurrent 5

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Other APPROVE Pay on Appeal Retro 7

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Other APPROVE Pay on Appeal Standard 1

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Other APPROVE Pay on Appeal Concurrent 1

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)CDMS-Fax APPROVE Pay Standard 5

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)CDMS-Fax APPROVE Pay Concurrent 1

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)CDMS-Fax DENY Admin Denial Standard 1

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)CDMS-Fax PP APPROVE Pay Standard 1

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)CDMS-Fax PP APPROVE Pay Concurrent 1

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Email

Event status

reason not

indicated in

source.

Retro 1

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Email APPROVE Pay Retro 6

Market Place

– ArkansasSilver

Other

Medical

Inpatient

Services (S&P)Email APPROVE Pay Concurrent 5

Market Place

– ArkansasSilver

Other

MedicalObservation Phone APPROVE

Event status

reason not

indicated in

source.

Level of

Urgency not

indicated in

source.

1

Page 27: June 2015 Outpatient Authorization Statistics Service ... · – Arkansas Silver Behavioral Health BH PHP Phone APPROVE Event status reason not indicated in source. Concurrent 1 Market

Market Place

– ArkansasSilver

Other

MedicalObservation Phone APPROVE Pay

Level of

Urgency not

indicated in

source.

14

Market Place

– ArkansasSilver

Other

MedicalObservation Phone APPROVE Pay Emergency 1

Market Place

– ArkansasSilver

Other

MedicalObservation Phone APPROVE Pay Urgent 1

Market Place

– ArkansasSilver

Other

MedicalObservation Phone APPROVE Pay Retro 122

Market Place

– ArkansasSilver

Other

MedicalObservation Phone APPROVE Pay Standard 114

Market Place

– ArkansasSilver

Other

MedicalObservation Phone APPROVE Pay Concurrent 344

Market Place

– ArkansasSilver

Other

MedicalObservation Phone APPROVE Pay on Appeal Retro 1

Market Place

– ArkansasSilver

Other

MedicalObservation Phone APPROVE

Special

Instructions

To Claims

Retro 1

Market Place

– ArkansasSilver

Other

MedicalObservation Phone APPROVE

Special

Instructions

To Claims

Standard 1

Market Place

– ArkansasSilver

Other

MedicalObservation Phone APPROVE

Special

Instructions

To Claims

Concurrent 2

Market Place

– ArkansasSilver

Other

MedicalObservation Phone PEND Pay Standard 1

Market Place

– ArkansasSilver

Other

MedicalObservation Phone PEND Pay Concurrent 1

Market Place

– ArkansasSilver

Other

MedicalObservation Fax APPROVE Pay

Level of

Urgency not

indicated in

source.

3

Market Place

– ArkansasSilver

Other

MedicalObservation Fax APPROVE Pay Retro 60

Page 28: June 2015 Outpatient Authorization Statistics Service ... · – Arkansas Silver Behavioral Health BH PHP Phone APPROVE Event status reason not indicated in source. Concurrent 1 Market

Market Place

– ArkansasSilver

Other

MedicalObservation Fax APPROVE Pay Standard 15

Market Place

– ArkansasSilver

Other

MedicalObservation Fax APPROVE Pay Concurrent 42

Market Place

– ArkansasSilver

Other

MedicalObservation Fax DENY Admin Denial Retro 1

Market Place

– ArkansasSilver

Other

MedicalObservation Web APPROVE

Event status

reason not

indicated in

source.

Level of

Urgency not

indicated in

source.

3

Market Place

– ArkansasSilver

Other

MedicalObservation Web APPROVE

Event status

reason not

indicated in

source.

Concurrent 1

Market Place

– ArkansasSilver

Other

MedicalObservation Web APPROVE Pay

Level of

Urgency not

indicated in

source.

2

Market Place

– ArkansasSilver

Other

MedicalObservation Web APPROVE Pay Urgent 2

Market Place

– ArkansasSilver

Other

MedicalObservation Web APPROVE Pay Non-Urgent 1

Market Place

– ArkansasSilver

Other

MedicalObservation Web APPROVE Pay Retro 57

Market Place

– ArkansasSilver

Other

MedicalObservation Web APPROVE Pay Standard 125

Market Place

– ArkansasSilver

Other

MedicalObservation Web APPROVE Pay Concurrent 204

Market Place

– ArkansasSilver

Other

MedicalObservation Web APPROVE Pay

Standard

Extension1

Market Place

– ArkansasSilver

Other

MedicalObservation Web APPROVE Pay on Appeal Standard 1

Market Place

– ArkansasSilver

Other

MedicalObservation Web DENY Pay Concurrent 1

Page 29: June 2015 Outpatient Authorization Statistics Service ... · – Arkansas Silver Behavioral Health BH PHP Phone APPROVE Event status reason not indicated in source. Concurrent 1 Market

Market Place

– ArkansasSilver

Other

MedicalObservation Web PEND

Special

Instructions

To Claims

Standard 1

Market Place

– ArkansasSilver

Other

MedicalObservation Other APPROVE Pay Retro 22

Market Place

– ArkansasSilver

Other

MedicalObservation Other APPROVE Pay Concurrent 1

Market Place

– ArkansasSilver

Other

MedicalObservation CDMS-Fax APPROVE Pay Retro 3

Market Place

– ArkansasSilver

Other

MedicalObservation CDMS-Fax APPROVE Pay Standard 3

Market Place

– ArkansasSilver

Other

MedicalObservation CDMS-Fax APPROVE Pay Concurrent 2

Market Place

– ArkansasSilver

Other

MedicalObservation Email APPROVE Pay Retro 65

Market Place

– ArkansasSilver

Other

MedicalObservation Email APPROVE Pay Concurrent 1

Market Place

– ArkansasSilver

Other

MedicalOffice Visit Phone APPROVE Pay Standard 1

Market Place

– ArkansasSilver

Other

Medical

Outpatient

ServicesPhone APPROVE Pay Standard 19

Market Place

– ArkansasSilver

Other

Medical

Outpatient

ServicesPhone APPROVE Pay Concurrent 2

Market Place

– ArkansasSilver

Other

Medical

Outpatient

ServicesPhone DENY

Denied by

Medical

Services

Urgent 2

Market Place

– ArkansasSilver

Other

Medical

Outpatient

ServicesPhone DENY

Denied by

Medical

Services

Standard 10

Market Place

– ArkansasSilver

Other

Medical

Outpatient

ServicesPhone DENY Admin Denial Urgent 1

Page 30: June 2015 Outpatient Authorization Statistics Service ... · – Arkansas Silver Behavioral Health BH PHP Phone APPROVE Event status reason not indicated in source. Concurrent 1 Market

Market Place

– ArkansasSilver

Other

Medical

Outpatient

ServicesFax APPROVE Pay Standard 2

Market Place

– ArkansasSilver

Other

Medical

Outpatient

ServicesFax DENY

Denied by

Medical

Services

Standard 1

Market Place

– ArkansasSilver

Other

Medical

Outpatient

ServicesFax DENY Admin Denial Retro 1

Market Place

– ArkansasSilver

Other

Medical

Outpatient

ServicesFax DENY Admin Denial Standard 1

Market Place

– ArkansasSilver

Other

Medical

Outpatient

ServicesFax PEND

Special

Instructions

To Claims

Standard 2

Market Place

– ArkansasSilver

Other

Medical

Outpatient

ServicesWeb APPROVE Pay Standard 18

Market Place

– ArkansasSilver

Other

Medical

Outpatient

ServicesWeb APPROVE Pay Concurrent 3

Market Place

– ArkansasSilver

Other

Medical

Outpatient

ServicesWeb DENY

Denied by

Medical

Services

Standard 2

Market Place

– ArkansasSilver

Other

Medical

Outpatient

Therapy (BH)Phone APPROVE

Event status

reason not

indicated in

source.

Concurrent 2

Market Place

– ArkansasSilver

Other

Medical

Outpatient

Therapy (BH)Phone APPROVE Pay Concurrent 5

Market Place

– ArkansasSilver

Other

Medical

Outpatient

Therapy (BH)Fax APPROVE

Event status

reason not

indicated in

source.

Level of

Urgency not

indicated in

source.

1

Market Place

– ArkansasSilver

Other

Medical

Outpatient

Therapy (BH)Fax APPROVE Pay Standard 5

Market Place

– ArkansasSilver

Other

Medical

Outpatient

Therapy (BH)Fax APPROVE Pay Concurrent 57

Market Place

– ArkansasSilver

Other

Medical

Outpatient

Therapy (BH)Fax DENY Admin Denial Retro 1

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Market Place

– ArkansasSilver

Other

Medical

Outpatient

Therapy (BH)Fax PEND

Special

Instructions

To Claims

Concurrent 2

Market Place

– ArkansasSilver

Other

Medical

Outpatient

Therapy (BH)Email APPROVE Pay Standard 1

Market Place

– ArkansasSilver

Other

Medical

Outpatient

SurgeryPhone APPROVE Pay

Level of

Urgency not

indicated in

source.

4

Market Place

– ArkansasSilver

Other

Medical

Outpatient

SurgeryPhone APPROVE Pay Retro 6

Market Place

– ArkansasSilver

Other

Medical

Outpatient

SurgeryPhone APPROVE Pay Standard 344

Market Place

– ArkansasSilver

Other

Medical

Outpatient

SurgeryPhone APPROVE Pay Stabilization 1

Market Place

– ArkansasSilver

Other

Medical

Outpatient

SurgeryPhone APPROVE Pay on Appeal Standard 1

Market Place

– ArkansasSilver

Other

Medical

Outpatient

SurgeryPhone APPROVE

Special

Instructions

To Claims

Retro 1

Market Place

– ArkansasSilver

Other

Medical

Outpatient

SurgeryPhone APPROVE

Denial Upheld

on AppealStandard 2

Market Place

– ArkansasSilver

Other

Medical

Outpatient

SurgeryPhone APPROVE Under Review Standard 4

Market Place

– ArkansasSilver

Other

Medical

Outpatient

SurgeryPhone DENY

Denied by

Medical

Services

Standard 21

Market Place

– ArkansasSilver

Other

Medical

Outpatient

SurgeryPhone DENY

Denial Upheld

on AppealStandard 1

Market Place

– ArkansasSilver

Other

Medical

Outpatient

SurgeryPhone PEND

Avoidable

ReadmissionStandard 1

Market Place

– ArkansasSilver

Other

Medical

Outpatient

SurgeryFax

Event status

reason not

indicated in

source.

Retro 1

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Market Place

– ArkansasSilver

Other

Medical

Outpatient

SurgeryFax APPROVE Pay Retro 2

Market Place

– ArkansasSilver

Other

Medical

Outpatient

SurgeryFax APPROVE Pay Standard 19

Market Place

– ArkansasSilver

Other

Medical

Outpatient

SurgeryFax DENY

Denied by

Medical

Services

Standard 3

Market Place

– ArkansasSilver

Other

Medical

Outpatient

SurgeryFax PEND Pay Standard 1

Market Place

– ArkansasSilver

Other

Medical

Outpatient

SurgeryMail DENY Admin Denial Standard 1

Market Place

– ArkansasSilver

Other

Medical

Outpatient

SurgeryWeb APPROVE Pay Standard 68

Market Place

– ArkansasSilver

Other

Medical

Outpatient

SurgeryWeb APPROVE Pay Concurrent 2

Market Place

– ArkansasSilver

Other

Medical

Outpatient

SurgeryWeb DENY

Denied by

Medical

Services

Standard 2

Market Place

– ArkansasSilver

Other

Medical

Outpatient

SurgeryWeb DENY Admin Denial Standard 2

Market Place

– ArkansasSilver

Other

Medical

Outpatient

SurgeryOther APPROVE Pay Retro 4

Market Place

– ArkansasSilver

Other

Medical

Outpatient

SurgeryCDMS-Fax APPROVE Pay Standard 3

Market Place

– ArkansasSilver

Other

Medical

Outpatient

SurgeryCDMS-Fax DENY

Denied by

Medical

Services

Standard 1

Market Place

– ArkansasSilver

Other

Medical

Outpatient

SurgeryEmail

Event status

reason not

indicated in

source.

Retro 1

Market Place

– ArkansasSilver

Other

Medical

Outpatient

SurgeryEmail APPROVE Pay Retro 6

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Market Place

– ArkansasSilver

Other

Medical

Pain

ManagementPhone

Event status

reason not

indicated in

source.

Standard 1

Market Place

– ArkansasSilver

Other

Medical

Pain

ManagementPhone APPROVE

Event status

reason not

indicated in

source.

Level of

Urgency not

indicated in

source.

3

Market Place

– ArkansasSilver

Other

Medical

Pain

ManagementPhone APPROVE Pay

Level of

Urgency not

indicated in

source.

13

Market Place

– ArkansasSilver

Other

Medical

Pain

ManagementPhone APPROVE Pay Urgent 4

Market Place

– ArkansasSilver

Other

Medical

Pain

ManagementPhone APPROVE Pay Retro 4

Market Place

– ArkansasSilver

Other

Medical

Pain

ManagementPhone APPROVE Pay Standard 457

Market Place

– ArkansasSilver

Other

Medical

Pain

ManagementPhone APPROVE Pay on Appeal Standard 1

Market Place

– ArkansasSilver

Other

Medical

Pain

ManagementPhone APPROVE

Special

Instructions

To Claims

Standard 1

Market Place

– ArkansasSilver

Other

Medical

Pain

ManagementPhone APPROVE

Denied by

Medical

Services

Standard 1

Market Place

– ArkansasSilver

Other

Medical

Pain

ManagementPhone APPROVE Under Review Standard 1

Market Place

– ArkansasSilver

Other

Medical

Pain

ManagementPhone DENY Pay Standard 2

Market Place

– ArkansasSilver

Other

Medical

Pain

ManagementPhone DENY

Denied by

Medical

Services

Level of

Urgency not

indicated in

source.

1

Market Place

– ArkansasSilver

Other

Medical

Pain

ManagementPhone DENY

Denied by

Medical

Services

Retro 1

Market Place

– ArkansasSilver

Other

Medical

Pain

ManagementPhone DENY

Denied by

Medical

Services

Standard 107

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Market Place

– ArkansasSilver

Other

Medical

Pain

ManagementPhone DENY Admin Denial Standard 3

Market Place

– ArkansasSilver

Other

Medical

Pain

ManagementPhone PEND Pay Standard 3

Market Place

– ArkansasSilver

Other

Medical

Pain

ManagementPhone PEND

Special

Instructions

To Claims

Standard 4

Market Place

– ArkansasSilver

Other

Medical

Pain

ManagementFax

Event status

reason not

indicated in

source.

Standard 4

Market Place

– ArkansasSilver

Other

Medical

Pain

ManagementFax APPROVE Pay

Level of

Urgency not

indicated in

source.

2

Market Place

– ArkansasSilver

Other

Medical

Pain

ManagementFax APPROVE Pay Retro 1

Market Place

– ArkansasSilver

Other

Medical

Pain

ManagementFax APPROVE Pay Standard 318

Market Place

– ArkansasSilver

Other

Medical

Pain

ManagementFax APPROVE Pay Concurrent 4

Market Place

– ArkansasSilver

Other

Medical

Pain

ManagementFax APPROVE Pay on Appeal Retro 1

Market Place

– ArkansasSilver

Other

Medical

Pain

ManagementFax APPROVE Pay on Appeal Standard 2

Market Place

– ArkansasSilver

Other

Medical

Pain

ManagementFax APPROVE

Special

Instructions

To Claims

Standard 2

Market Place

– ArkansasSilver

Other

Medical

Pain

ManagementFax APPROVE

Denial Upheld

on AppealConcurrent 1

Market Place

– ArkansasSilver

Other

Medical

Pain

ManagementFax DENY

Denied by

Medical

Services

Retro 6

Market Place

– ArkansasSilver

Other

Medical

Pain

ManagementFax DENY

Denied by

Medical

Services

Standard 44

Page 35: June 2015 Outpatient Authorization Statistics Service ... · – Arkansas Silver Behavioral Health BH PHP Phone APPROVE Event status reason not indicated in source. Concurrent 1 Market

Market Place

– ArkansasSilver

Other

Medical

Pain

ManagementFax DENY

Denied by

Medical

Services

Concurrent 1

Market Place

– ArkansasSilver

Other

Medical

Pain

ManagementWeb

Event status

reason not

indicated in

source.

Standard 11

Market Place

– ArkansasSilver

Other

Medical

Pain

ManagementWeb APPROVE

Event status

reason not

indicated in

source.

Level of

Urgency not

indicated in

source.

1

Market Place

– ArkansasSilver

Other

Medical

Pain

ManagementWeb APPROVE Pay

Level of

Urgency not

indicated in

source.

9

Market Place

– ArkansasSilver

Other

Medical

Pain

ManagementWeb APPROVE Pay Urgent 20

Market Place

– ArkansasSilver

Other

Medical

Pain

ManagementWeb APPROVE Pay Standard 569

Market Place

– ArkansasSilver

Other

Medical

Pain

ManagementWeb APPROVE

Special

Instructions

To Claims

Standard 1

Market Place

– ArkansasSilver

Other

Medical

Pain

ManagementWeb APPROVE

Denied by

Medical

Services

Standard 1

Market Place

– ArkansasSilver

Other

Medical

Pain

ManagementWeb APPROVE

Denial Upheld

on AppealStandard 1

Market Place

– ArkansasSilver

Other

Medical

Pain

ManagementWeb APPROVE Under Review Standard 1

Market Place

– ArkansasSilver

Other

Medical

Pain

ManagementWeb DENY Pay Standard 1

Market Place

– ArkansasSilver

Other

Medical

Pain

ManagementWeb DENY

Denied by

Medical

Services

Level of

Urgency not

indicated in

source.

3

Market Place

– ArkansasSilver

Other

Medical

Pain

ManagementWeb DENY

Denied by

Medical

Services

Urgent 5

Market Place

– ArkansasSilver

Other

Medical

Pain

ManagementWeb DENY

Denied by

Medical

Services

Standard 100

Page 36: June 2015 Outpatient Authorization Statistics Service ... · – Arkansas Silver Behavioral Health BH PHP Phone APPROVE Event status reason not indicated in source. Concurrent 1 Market

Market Place

– ArkansasSilver

Other

Medical

Pain

ManagementWeb PEND

Special

Instructions

To Claims

Standard 7

Market Place

– ArkansasSilver

Other

Medical

Pain

ManagementOther APPROVE Pay Retro 2

Market Place

– ArkansasSilver

Other

Medical

Pain

ManagementCDMS-Fax APPROVE Pay Standard 8

Market Place

– ArkansasSilver

Other

Medical

Pain

ManagementEmail APPROVE Pay Retro 20

Market Place

– ArkansasSilver

Other

Medical

Professional

Fees (BH)Phone APPROVE Pay Concurrent 25

Market Place

– ArkansasSilver

Other

Medical

Professional

Fees (BH)Phone DENY

Denied by

Medical

Services

Concurrent 1

Market Place

– ArkansasSilver

Other

Medical

Professional

Fees (BH)Phone DENY

Denial Upheld

on AppealConcurrent 1

Market Place

– ArkansasSilver

Other

Medical

Professional

Fees (BH)Phone DENY Admin Denial Concurrent 2

Market Place

– ArkansasSilver

Other

Medical

Professional

Fees (BH)Phone PEND

Special

Instructions

To Claims

Concurrent 1

Market Place

– ArkansasSilver

Other

Medical

Professional

Fees (BH)Fax APPROVE Pay Retro 2

Market Place

– ArkansasSilver

Other

Medical

Professional

Fees (BH)Fax APPROVE Pay Concurrent 4

Market Place

– ArkansasSilver

Other

MedicalRehab Web DENY Admin Denial Standard 1

Market Place

– ArkansasSilver

Other

MedicalSleep Study Phone

Event status

reason not

indicated in

source.

Standard 1

Market Place

– ArkansasSilver

Other

MedicalSleep Study Phone APPROVE Pay

Level of

Urgency not

indicated in

source.

19

Page 37: June 2015 Outpatient Authorization Statistics Service ... · – Arkansas Silver Behavioral Health BH PHP Phone APPROVE Event status reason not indicated in source. Concurrent 1 Market

Market Place

– ArkansasSilver

Other

MedicalSleep Study Phone APPROVE Pay Urgent 6

Market Place

– ArkansasSilver

Other

MedicalSleep Study Phone APPROVE Pay Retro 2

Market Place

– ArkansasSilver

Other

MedicalSleep Study Phone APPROVE Pay Expedited 2

Market Place

– ArkansasSilver

Other

MedicalSleep Study Phone APPROVE Pay Standard 849

Market Place

– ArkansasSilver

Other

MedicalSleep Study Phone APPROVE Pay Stabilization 3

Market Place

– ArkansasSilver

Other

MedicalSleep Study Phone APPROVE Pay Concurrent 2

Market Place

– ArkansasSilver

Other

MedicalSleep Study Phone APPROVE

Denied by

Medical

Services

Standard 1

Market Place

– ArkansasSilver

Other

MedicalSleep Study Phone APPROVE

Denial Upheld

on AppealStandard 1

Market Place

– ArkansasSilver

Other

MedicalSleep Study Phone DENY

Denied by

Medical

Services

Level of

Urgency not

indicated in

source.

1

Market Place

– ArkansasSilver

Other

MedicalSleep Study Phone DENY

Denied by

Medical

Services

Standard 17

Market Place

– ArkansasSilver

Other

MedicalSleep Study Phone DENY Admin Denial Standard 3

Market Place

– ArkansasSilver

Other

MedicalSleep Study Phone PEND Pay Standard 2

Market Place

– ArkansasSilver

Other

MedicalSleep Study Phone PEND

Denied by

Medical

Services

Standard 2

Market Place

– ArkansasSilver

Other

MedicalSleep Study Fax APPROVE Pay Standard 43

Page 38: June 2015 Outpatient Authorization Statistics Service ... · – Arkansas Silver Behavioral Health BH PHP Phone APPROVE Event status reason not indicated in source. Concurrent 1 Market

Market Place

– ArkansasSilver

Other

MedicalSleep Study Fax APPROVE Pay Concurrent 2

Market Place

– ArkansasSilver

Other

MedicalSleep Study Fax DENY Admin Denial Standard 2

Market Place

– ArkansasSilver

Other

MedicalSleep Study Web

Event status

reason not

indicated in

source.

Standard 5

Market Place

– ArkansasSilver

Other

MedicalSleep Study Web APPROVE Pay

Level of

Urgency not

indicated in

source.

15

Market Place

– ArkansasSilver

Other

MedicalSleep Study Web APPROVE Pay Urgent 2

Market Place

– ArkansasSilver

Other

MedicalSleep Study Web APPROVE Pay Standard 658

Market Place

– ArkansasSilver

Other

MedicalSleep Study Web APPROVE Pay on Appeal Standard 3

Market Place

– ArkansasSilver

Other

MedicalSleep Study Web APPROVE

Denied by

Medical

Services

Standard 2

Market Place

– ArkansasSilver

Other

MedicalSleep Study Web APPROVE Under Review Standard 1

Market Place

– ArkansasSilver

Other

MedicalSleep Study Web DENY

Denied by

Medical

Services

Standard 10

Market Place

– ArkansasSilver

Other

MedicalSleep Study Other APPROVE Pay Retro 1

Market Place

– ArkansasSilver

Other

MedicalSleep Study CDMS-Fax APPROVE Pay Standard 3

Market Place

– ArkansasSilver

Other

MedicalTransport Phone APPROVE Pay Standard 1

Market Place

– ArkansasSilver

Other

MedicalTransport Fax PEND

Special

Instructions

To Claims

Retro 1

Page 39: June 2015 Outpatient Authorization Statistics Service ... · – Arkansas Silver Behavioral Health BH PHP Phone APPROVE Event status reason not indicated in source. Concurrent 1 Market

Market Place

– ArkansasSilver

Other

MedicalVendor Phone APPROVE Pay on Appeal Urgent 1

Market Place

– ArkansasSilver

Other

MedicalVendor Phone DENY Admin Denial Standard 1

Market Place

– ArkansasSilver

Other

MedicalVendor Fax APPROVE Pay on Appeal Urgent 3

Market Place

– ArkansasSilver

Other

MedicalVendor Fax APPROVE Pay on Appeal Standard 3

Market Place

– ArkansasSilver

Other

MedicalVendor Fax APPROVE Admin Denial Stabilization 1

Market Place

– ArkansasSilver

Other

MedicalVendor Fax DENY

Denied by

Medical

Services

Standard 1

Market Place

– ArkansasSilver

Other

MedicalVendor Fax DENY

Denial Upheld

on AppealUrgent 2

Market Place

– ArkansasSilver

Other

MedicalVendor Fax DENY

Denial Upheld

on AppealStandard 10

Market Place

– ArkansasSilver

Other

MedicalVendor Fax DENY Admin Denial Urgent 1

Market Place

– ArkansasSilver

Other

MedicalVendor Fax DENY Admin Denial Retro 1

Market Place

– ArkansasSilver

Other

MedicalVendor Fax DENY Admin Denial Standard 41

Market Place

– ArkansasSilver

Other

MedicalVendor Mail DENY Admin Denial Standard 1

Market Place

– ArkansasSilver

Other

Medical

Electroconvulsi

ve TherapyFax APPROVE Pay Concurrent 4

Market Place

– ArkansasSilver

Other

Medical

Electroconvulsi

ve TherapyFax DENY

Denied by

Medical

Services

Concurrent 1

Page 40: June 2015 Outpatient Authorization Statistics Service ... · – Arkansas Silver Behavioral Health BH PHP Phone APPROVE Event status reason not indicated in source. Concurrent 1 Market

Market Place

– ArkansasSilver

Other

Medical

Electroconvulsi

ve TherapyOther DENY

Denied by

Medical

Services

Retro 1

Market Place

– ArkansasSilver

Other

MedicalPsych Testing Phone APPROVE Pay

Level of

Urgency not

indicated in

source.

1

Market Place

– ArkansasSilver

Other

MedicalPsych Testing Phone APPROVE Pay Concurrent 3

Market Place

– ArkansasSilver

Other

MedicalPsych Testing Phone APPROVE

Pend Partial

ApprovalConcurrent 1

Market Place

– ArkansasSilver

Other

MedicalPsych Testing Phone DENY Pay Concurrent 1

Market Place

– ArkansasSilver

Other

MedicalPsych Testing Phone DENY

Pend Partial

ApprovalConcurrent 1

Market Place

– ArkansasSilver

Other

MedicalPsych Testing Phone DENY

Denied by

Medical

Services

Concurrent 1

Market Place

– ArkansasSilver

Other

MedicalPsych Testing Fax APPROVE Pay Retro 2

Market Place

– ArkansasSilver

Other

MedicalPsych Testing Fax APPROVE Pay Concurrent 69

Market Place

– ArkansasSilver

Other

MedicalPsych Testing Fax APPROVE

Pend Partial

ApprovalRetro 2

Market Place

– ArkansasSilver

Other

MedicalPsych Testing Fax APPROVE

Pend Partial

ApprovalConcurrent 7

Market Place

– ArkansasSilver

Other

MedicalPsych Testing Fax APPROVE

Special

Instructions

To Claims

Concurrent 1

Market Place

– ArkansasSilver

Other

MedicalPsych Testing Fax DENY Pay Concurrent 6

Market Place

– ArkansasSilver

Other

MedicalPsych Testing Fax DENY

Pend Partial

ApprovalRetro 2

Page 41: June 2015 Outpatient Authorization Statistics Service ... · – Arkansas Silver Behavioral Health BH PHP Phone APPROVE Event status reason not indicated in source. Concurrent 1 Market

Market Place

– ArkansasSilver

Other

MedicalPsych Testing Fax DENY

Pend Partial

ApprovalConcurrent 7

Market Place

– ArkansasSilver

Other

MedicalPsych Testing Fax DENY

Special

Instructions

To Claims

Concurrent 1

Market Place

– ArkansasSilver

Other

MedicalPsych Testing Fax DENY

Denied by

Medical

Services

Concurrent 9

Market Place

– ArkansasSilver

Other

MedicalOrthotics Phone

Event status

reason not

indicated in

source.

Concurrent 1

Market Place

– ArkansasSilver

Other

MedicalOrthotics Phone APPROVE Pay

Level of

Urgency not

indicated in

source.

2

Market Place

– ArkansasSilver

Other

MedicalOrthotics Phone APPROVE Pay Urgent 1

Market Place

– ArkansasSilver

Other

MedicalOrthotics Phone APPROVE Pay Standard 107

Market Place

– ArkansasSilver

Other

MedicalOrthotics Phone APPROVE Pay Concurrent 5

Market Place

– ArkansasSilver

Other

MedicalOrthotics Phone APPROVE Pay on Appeal Standard 2

Market Place

– ArkansasSilver

Other

MedicalOrthotics Phone DENY

Denied by

Medical

Services

Standard 7

Market Place

– ArkansasSilver

Other

MedicalOrthotics Phone PEND

Special

Instructions

To Claims

Standard 1

Market Place

– ArkansasSilver

Other

MedicalOrthotics Fax APPROVE Pay Retro 2

Market Place

– ArkansasSilver

Other

MedicalOrthotics Fax APPROVE Pay Standard 12

Market Place

– ArkansasSilver

Other

MedicalOrthotics Fax DENY

Denied by

Medical

Services

Standard 1

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Market Place

– ArkansasSilver

Other

MedicalOrthotics Web

Event status

reason not

indicated in

source.

Standard 1

Market Place

– ArkansasSilver

Other

MedicalOrthotics Web APPROVE Pay

Level of

Urgency not

indicated in

source.

1

Market Place

– ArkansasSilver

Other

MedicalOrthotics Web APPROVE Pay Standard 159

Market Place

– ArkansasSilver

Other

MedicalOrthotics Web APPROVE Pay Concurrent 1

Market Place

– ArkansasSilver

Other

MedicalOrthotics Web DENY

Denied by

Medical

Services

Standard 7

Market Place

– ArkansasSilver

Other

MedicalOrthotics Web PEND

Special

Instructions

To Claims

Standard 2

Market Place

– ArkansasSilver

Other

MedicalOrthotics CDMS-Fax APPROVE Pay Standard 2

Market Place

– ArkansasSilver

Other

MedicalOrthotics CDMS-Fax APPROVE

Denial Upheld

on AppealStandard 1

Market Place

– ArkansasSilver

Other

MedicalProsthetics Phone

Event status

reason not

indicated in

source.

Standard 2

Market Place

– ArkansasSilver

Other

MedicalProsthetics Phone APPROVE Pay

Level of

Urgency not

indicated in

source.

4

Market Place

– ArkansasSilver

Other

MedicalProsthetics Phone APPROVE Pay Retro 1

Market Place

– ArkansasSilver

Other

MedicalProsthetics Phone APPROVE Pay Standard 45

Market Place

– ArkansasSilver

Other

MedicalProsthetics Fax APPROVE Pay Retro 1

Market Place

– ArkansasSilver

Other

MedicalProsthetics Fax APPROVE Pay Standard 7

Page 43: June 2015 Outpatient Authorization Statistics Service ... · – Arkansas Silver Behavioral Health BH PHP Phone APPROVE Event status reason not indicated in source. Concurrent 1 Market

Market Place

– ArkansasSilver

Other

MedicalProsthetics Fax DENY

Denied by

Medical

Services

Standard 1

Market Place

– ArkansasSilver

Other

MedicalProsthetics Web

Event status

reason not

indicated in

source.

Standard 1

Market Place

– ArkansasSilver

Other

MedicalProsthetics Web APPROVE Pay Standard 23

Market Place

– ArkansasSilver

Other

MedicalProsthetics Web DENY

Denied by

Medical

Services

Urgent 1

Market Place

– ArkansasSilver

Other

MedicalProsthetics Web PEND Pay Standard 1

Market Place

– ArkansasSilver

Other

Medical

Community

Based ServicesPhone APPROVE Pay Concurrent 2

Market Place

– ArkansasSilver

Other

Medical

Intensive

Outpatient

Program

Phone APPROVE Pay Concurrent 47

Market Place

– ArkansasSilver

Other

Medical

Intensive

Outpatient

Program

Phone DENY

Denied by

Medical

Services

Concurrent 4

Market Place

– ArkansasSilver

Other

Medical

Intensive

Outpatient

Program

Fax APPROVE Pay

Level of

Urgency not

indicated in

source.

4

Market Place

– ArkansasSilver

Other

Medical

Intensive

Outpatient

Program

Fax APPROVE Pay Standard 2

Market Place

– ArkansasSilver

Other

Medical

Intensive

Outpatient

Program

Fax APPROVE Pay Stabilization 1

Market Place

– ArkansasSilver

Other

Medical

Intensive

Outpatient

Program

Fax APPROVE Pay Concurrent 89

Market Place

– ArkansasSilver

Other

Medical

Intensive

Outpatient

Program

Fax DENY

Denied by

Medical

Services

Concurrent 2

Market Place

– ArkansasSilver

Other

Medical

Intensive

Outpatient

Program

Fax DENY Admin Denial Retro 1

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Market Place

– ArkansasSilver

Other

Medical

Intensive

Outpatient

Program

Fax DENY Admin Denial Concurrent 1

Market Place

– ArkansasSilver

Other

Medical

Intensive

Outpatient

Program

Fax PEND

Special

Instructions

To Claims

Concurrent 1

Market Place

– ArkansasSilver

Other

MedicalDrug Testing Phone APPROVE Pay Retro 14

Market Place

– ArkansasSilver

Other

MedicalDrug Testing Phone APPROVE Pay Standard 69

Market Place

– ArkansasSilver

Other

MedicalDrug Testing Phone DENY

Denied by

Medical

Services

Standard 11

Market Place

– ArkansasSilver

Other

MedicalDrug Testing Fax

Event status

reason not

indicated in

source.

Retro 8

Market Place

– ArkansasSilver

Other

MedicalDrug Testing Fax APPROVE Pay Retro 54

Market Place

– ArkansasSilver

Other

MedicalDrug Testing Fax APPROVE Pay Standard 256

Market Place

– ArkansasSilver

Other

MedicalDrug Testing Web APPROVE

Event status

reason not

indicated in

source.

Level of

Urgency not

indicated in

source.

10

Market Place

– ArkansasSilver

Other

MedicalDrug Testing Web APPROVE Pay

Level of

Urgency not

indicated in

source.

12

Market Place

– ArkansasSilver

Other

MedicalDrug Testing Web APPROVE Pay Urgent 133

Market Place

– ArkansasSilver

Other

MedicalDrug Testing Web APPROVE Pay Standard 3,663

Market Place

– ArkansasSilver

Other

MedicalDrug Testing Web APPROVE Pay Concurrent 11

Market Place

– ArkansasSilver

Other

MedicalDrug Testing Web APPROVE

Denied by

Medical

Services

Standard 6

Page 45: June 2015 Outpatient Authorization Statistics Service ... · – Arkansas Silver Behavioral Health BH PHP Phone APPROVE Event status reason not indicated in source. Concurrent 1 Market

Market Place

– ArkansasSilver

Other

MedicalDrug Testing Web APPROVE

Denial Upheld

on AppealStandard 4

Market Place

– ArkansasSilver

Other

MedicalDrug Testing Web DENY

Denied by

Medical

Services

Standard 30

Market Place

– ArkansasSilver

Other

MedicalDrug Testing Web PEND Pay Standard 10

Market Place

– ArkansasSilver

Other

MedicalDrug Testing Web PEND

Special

Instructions

To Claims

Standard 1

Market Place

– ArkansasSilver

Other

MedicalDrug Testing CDMS-Fax APPROVE Pay Standard 47

Market Place

– ArkansasSilver

Other

MedicalDrug Testing Email APPROVE Pay Retro 8

Market Place

– ArkansasSilver

Other

MedicalOB Ultrasound Phone APPROVE Pay

Level of

Urgency not

indicated in

source.

1

Market Place

– ArkansasSilver

Other

MedicalOB Ultrasound Phone APPROVE Pay Retro 5

Market Place

– ArkansasSilver

Other

MedicalOB Ultrasound Phone APPROVE Pay Standard 88

Market Place

– ArkansasSilver

Other

MedicalOB Ultrasound Phone APPROVE Pay Concurrent 1

Market Place

– ArkansasSilver

Other

MedicalOB Ultrasound Phone APPROVE

Denied by

Medical

Services

Standard 1

Market Place

– ArkansasSilver

Other

MedicalOB Ultrasound Fax APPROVE Pay Retro 3

Market Place

– ArkansasSilver

Other

MedicalOB Ultrasound Fax APPROVE Pay Standard 8

Market Place

– ArkansasSilver

Other

MedicalOB Ultrasound Fax APPROVE Pay

Standard

Extension1

Page 46: June 2015 Outpatient Authorization Statistics Service ... · – Arkansas Silver Behavioral Health BH PHP Phone APPROVE Event status reason not indicated in source. Concurrent 1 Market

Market Place

– ArkansasSilver

Other

MedicalOB Ultrasound Web APPROVE Pay Urgent 1

Market Place

– ArkansasSilver

Other

MedicalOB Ultrasound Web APPROVE Pay Retro 4

Market Place

– ArkansasSilver

Other

MedicalOB Ultrasound Web APPROVE Pay Standard 31

Market Place

– ArkansasSilver

Other

MedicalOB Ultrasound Web DENY

Denied by

Medical

Services

Standard 1

Market Place

– ArkansasSilver

Other

MedicalOB Ultrasound CDMS-Fax APPROVE Pay Standard 1

Market Place

– ArkansasSilver

Other

MedicalOB Ultrasound CDMS-Fax PEND Pay Standard 1

Market Place

– ArkansasSilver

Other

MedicalOB Ultrasound Email APPROVE Pay Retro 1

Market Place

– ArkansasSilver

Other

Medical

Psychiatric

EvaluationFax APPROVE Pay Concurrent 2

Market Place

– ArkansasSilver

Other

Medical

BH Med

ManagementFax APPROVE Pay Concurrent 1

Market Place

– ArkansasSilver

Other

Medical

Hyperbaric

Oxygen

Therapy

Phone APPROVE Pay Standard 22

Market Place

– ArkansasSilver

Other

Medical

Hyperbaric

Oxygen

Therapy

Phone APPROVEDenial Upheld

on AppealStandard 1

Market Place

– ArkansasSilver

Other

Medical

Hyperbaric

Oxygen

Therapy

Phone DENY

Denied by

Medical

Services

Standard 2

Market Place

– ArkansasSilver

Other

Medical

Hyperbaric

Oxygen

Therapy

Fax APPROVE Pay Standard 1

Market Place

– ArkansasSilver

Other

Medical

Hyperbaric

Oxygen

Therapy

Web APPROVE Pay Standard 3

Page 47: June 2015 Outpatient Authorization Statistics Service ... · – Arkansas Silver Behavioral Health BH PHP Phone APPROVE Event status reason not indicated in source. Concurrent 1 Market

Market Place

– ArkansasSilver

Other

Medical

Hyperbaric

Oxygen

Therapy

Web DENY

Denied by

Medical

Services

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Market Place

– ArkansasSilver

Other

MedicalInfertility Phone APPROVE Pay Retro 1

Market Place

– ArkansasSilver

Other

MedicalInfertility Fax APPROVE Pay Standard 6

Market Place

– ArkansasSilver

Other

MedicalInfertility Fax DENY

Denied by

Medical

Services

Standard 2

Market Place

– ArkansasSilver

Other

MedicalInfertility Web DENY

Denied by

Medical

Services

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