• # of claims are updated monthly to allow for claims run out
• Imminent harm codes are not included in the waived list
• Data is generated using updated list of procedure codes in MMIS

This performance measure is important because it shows the number of paid claims for three categories of service (Dental, Imaging, and Durable Medical Equipment (DME)) that prior authorizations were waived for in response to COVID.

During the initial and acute phase of COVID, prior authorization requirements were waived for these specific service categories. With the adoption and utilization of telemedicine and COVID safety protocols, the delivery of equipment and services began to increase, resulting in increased claims. DVHA monitors this data quarterly and current evidence demonstrates stable trending to support continued waiving of prior authorization requirements.   Additionally, administrative burden has been reduced as it is not necessary for providers to submit a request for prior authorization for such services.  

The number of paid claims was noticeably reduced in CY20 due to the acute phase of the public health emergency.  Subsequent CY21, CY22, and CY23 are trending similarly to prior to the public health emergency in CY19. 

Last updated: 02/12/24

• AHS Policy
• Clinical Services Team
• DVHA Data Unit

DVHA will continue to monitor the number of paid claims on a quarterly basis post the public health emergency to evaluate trends in the volume of number of paid claims for these service areas no longer requiring prior authorization.