Table 2 Reasons for prior authorization request denial among 4,535 requests, n = 908.
n (%) | |
|---|---|
Not medically necessary/not essential for medical management | 282 (31.06) |
Experimental/investigational | 215 (23.68) |
No medical management justification | 99 (10.90) |
Does not meet criteria | 87 (9.58) |
No reason for denial provided or recorded | 79 (8.70) |
Not a covered benefit | 69 (7.60) |
Out of network/insurance error | 19 (2.09) |
Stepwise testing required | 39 (4.30) |
Already performed/only covered once | 9 (0.99) |
CPT code error | 6 (0.66) |
Clinical diagnosis | 4 (0.44) |
