Arkansas State Specific UM Statistics for Prior Authorizations
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1 Arkansas State Specific UM Statistics for Prior Authorizations Quarter One Quarter Two Quarter Three Quarter Four 2018 Quarter One Quarter Two Quarter Three Quarter Four
2 2016 Number of Prior Auth Review Service Requests reviewed Q1 Q2 Q3 Q4 1/1/16 3/31/16 4/1/16 6/30/16 7/1/16 9/30/16 10/1/16-12/ Number Approved 1 1 Number Denied 0 0 Treating Physician Bariatric Surgeon Neurological Specialties Surgeon Review Service Bariatric Surgery Incise Skull (pressure Requests relief) Hypertension Compression of brain Reasons for Denial, if applicable 2017 Number of Prior Auth Review Service Requests reviewed Number Approved Number Denied Treating Physician Specialties Review Service Requests Reasons for Denial, if applicable Q1 1/1/17 3/31/17 0
3 2017 Quarter Two Approved Denied Number of Prior Auth Review 0 0 Service Requests Reviewed Treating Physician Specialties Review Service Requests Reason for denial, if applicable
4 Arkansas statistics from 7/1/17 9/30/17, Quarter Three 2017 Top 10 Surgery OB/GYN Cardiovascular Surgery Physical Medicine and Rehabilitation Top 10 Surgery Radiation Oncology Top 10 s and Descriptions Approve Deny Total Top 10 s and Descriptions Approve Deny Total Description Description Total Knee Replacement Therapeutic Exercises Total Hip Replacement MRI, joint of lower extremity, without dye Initial Hospital Care MRI, lumbar spine without dye Hysterectomy MRI, brain stem with/out dye Laparoscopic Sleeve Gastrectomy CT, abdomen and pelvis with contrast Laparoscopic Gastric Bypass/Roux-En-Y CT, thorax with dye Neck Spine Fusion & Removal MRI, neck spine without dye Lumbar Spinal Fusion MRI, joint of upper extremity, without dye H2036 Psych Partial Hospitalization CT, abdomen and pelvis without contrast EEG Monitoring CT, abdomen and pelvis 1/> regns Top 10 s and Descriptions Approve Deny Total Top 10 s and Descriptions Approve Deny Total Description Description M1712 Unilateral Primary Osteoarthritis M545 Lower Back Pain E6601 Morbid Obesity M25561 Pain Right Knee M1711 Unilateral Primary Osteoarthritis M542 Cervicalgia M1611 Unilateral Primary Osteoarthritis M25562 Pain Left Knee M4806 Spinal Stenosis, Lumbar R109 Abdominal Pain M1612 Unilateral Primary Osteoarthritis M25512 Pain Left Shoulder D259 Leiomyoma Uterus M5416 Radiculopathy Lumbar R569 Convulsions, NOS M25511 Pain Right Shoulder I2510 ASHD Native Coronary Artery R51 Headache M4802 Spinal Stenosis, cervical M5412 Radiculopathy Cervical
5 Arkansas statistics from 10/1/17 12/31/17 Family and General Practice Obstetrics and Gynecology Thoracic Surgery Cardiovascular Surgery Psychiatry Surgical Plastic Surgery Nephrology Colon and Rectal Surgery Top 10 IP s and Descriptions Approve Deny Total Top 10 OP s and Descriptions Approve Deny Total Description Description Total Knee Replacement Therapeutic Exercises Total Hip Replacement MRI of Lower Extremity w/o Laparoscopic Sleeve Gastrectomy MRI of Lumbar Spine w/o Total Hysterectomy MRI of Brain Stem w/o and w/ Initial Hospital Care CT of Abdomin and Pelvis w/contrast Lumbar Spinal Fusion, Combined CT Thorax w/ Obstetrical Care MRI Neck Spine w/o Laparoscopic Gastric Bypass/Roux-En-Y MRI Joint Upper Extremity w/o Neck Spine Fusion & Remove Bel C CT Abdomin & Pelvis w/o Contrast Laparoscopic Radical Prostatectomy CT Abdomin & Pelvis 1/> Regns Reconstruction of Shoulder Joint CT Maxillofacial w/o Top 10 IP s and Descriptions Approve Deny Total Top 10 OP s and Descriptions Approve Deny Total Description Description E6601 Morbid Obesity D/T Excessive Calories M545 Low Back Pain M1711 Unilateral Primary Osteoarthritis M542 Cervicalgia M1712 Unilateral Primary Osteoarthritis M25562 Left Knee Pain Full-Term Uncomplicated Pregnancy M25511 Right Shoulder Pain M1611 Unilateral Primary Osteoarthritis M25561 Right Knee pain C61 Malignant Neoplasm Prostate R51 Headache M1612 Unilateral Primary Osteoarthritis M5416 Lumbar Radiculopathy N2889 Specified Disorders Kidney R109 Abdominal Pain D259 Leiomyoma Uterus M5412 Radiculopathy Cervical Region M5126 Lumbar Disc Displacement NEC M25512 Left Shoulder Pain
6 Quarter One, Arkansas statistics from 1/1/18 3/31/18 Obstetrics and Gynecology Cardiovascular Thoracic Surgery Gynecology Oncology Nephrology Top 10 IP s and Descriptions Approve Deny Total Top 10 OP s and Descriptions Approve Deny Total Description Description Total Knee Arthroplasty Therapeutic Exercises Obstetrical Care MRI of Lower Extremity w/o Cesarean Delivery MRI of Lumbar Spine w/o Total Hip Arthroplasty MRI Brain Stem with/without Total Hysterectomy CT of Thorax w/ Lumbar Spine Fusion CT of Abdomen/Pelvis w/contrast Neck Spine Fusion & Remove Bel C MRI Upper Extremity w/o Video EEG Monitoring MRI Neck Spine w/o Laparoscopic Sleeve Gastrectomy CT Abdomen/Pelvis Laparoscopic Partial Colectomy CT Abdomen/Pelvis w/o Laparoscopic Radical Prostatectomy CT Maxillofacial w/o Top 10 IP s and Descriptions Approve Deny Total Top 10 OP s and Descriptions Approve Deny Total O80 Description M545 Low Back Pain Description Encounter for Full-Term Uncomp Pregnancy O82 Encounter for Cesarean Delivery M542 Cervicalgia M1711 Unilateral Primary Osteoarthritis M25561 Right Knee Pain M1712 Unilateral Primary Osteoarthritis R51 Headache E6601 Morbid Obesity M25562 Left Knee Pain M5136 IV Disc Degeneration NEC Lumbar M25511 Right Shoulder Pain M1612 Unilateral Primary Osteoarthritis M25512 Left Shoulder Pain M1611 Unilateral Primary Osteoarthritis R109 Abdominal Pain C61 Malignant Neoplasm Prostate M5416 Radiculopathy Lumbar Region D259 Leiomyoma Uterus NOS R911 Solitary Pulmonary Nodule
7 Quarter Two, Arkansas statistics from 4/1/18 6/30/18 Obstetrics and Gynecology Thoracic Surgery Cardiovascular Cardiovascular Obstetrics and Gynecology Top 10 IP s and Descriptions Approve Deny Total Top 10 OP s and Descriptions Approve Deny Total Description Description Total Knee Arthroplasty Therapeutic Exercises Obstetrical Care MRI Lumbar Spine w/o Laparoscopic Sleeve MRI Lower Extremity Joint Gastrectomy w/o Cesarean Delivery MRI Brain Stem Total Hip Arthroplasty CT Thorax w/ Laparoscopic Gastric CT Abdomen & Pelvis Bypass/Roux-En-Y w/contrast Total Hysterectomy MRI Neck Spine w/o Neck Spine Fusion MRI Upper Extremity joint w/o Lumbar Spine Fusion Combined CT Abdomen & Pelvis Rehabilitation Facility Inpatient Home Visits Top 10 IP s and Descriptions Approve Deny Total Top 10 OP s and Descriptions Approve Deny Total Description Description E6601 Morbid Obesity M25562 Left Knee Pain O80 Encounter for full term M542 Cervicalgia uncomplicated pregnancy O82 Cesarean Delivery M545 Low Back Pain M1711 Unilateral Primary Osteoarthritis M25561 Right Knee Pain M1712 Unilateral Primary Osteoarthritis M25511 Right Shoulder Pain M1611 Unilateral Primary Osteoarthritis R51 Headache M1612 Unilateral Primary Osteoarthritis R109 Abdominal Pain D259 Leiomyoma of Uterus NOS R911 Solitary Pulmonary Nodule M5136 Disc Degeneration NEC Lumbar M25512 Left Shoulder Pain M5116 Disc Disorders with Radiculopathy M5416 Lumbar Radiculopathy
8 Quarter Three, Arkansas statistics from 7/1/18 9/30/18 Obstetrics & Gynecology Family & General Practice Family & General Practice Thoracic Surgery Cardiovascular Surgery Nephrology Top 10 IP s and Descriptions Approve Deny Total Top 10 OP s and Descriptions Approve Deny Total Description Description Obstetrical Care Therapeutic Exercises Laparoscopic Sleeve Gastrectomy MRI Lower Extremity Joint w/o Cesarean Delivery MRI Lumbar Spine w/o Total Knee Arthroplasty CT Thorax w/ Neck Spinal Fusion MRI Brain Stem w/ and w/o Total Hip Arthroplasty CT Abdomen & Pelvis w/contrast Initial Hospital Care Skilled Nursing MRI Neck & Spine w/o Facility Total Hysterectomy MRI Upper Extremity Joint w/o Lap Gastric Bypass/Roux-En-Y CT Abdomen & Pelvis w/o Contrast Initial Hospital Care Long Term Acute Care and Rehabilitation CT Abdomen & Pelvis 1/>Regns Top 10 IP s and Descriptions Approve Deny Total Top 10 OP s and Descriptions Approve Deny Total Description Description O80 Encounter for Full Term Uncomp M545 Low Back Pain Pregnancy E6601 Morbid Obesity M25561 Right Knee Pain O82 Cesarean Delivery M542 Cervicalgia M1711 Unilateral Primary Osteoarthritis M25562 Left Knee Pain M1712 Unilateral Primary Osteoarthritis M5416 Radiculopathy Lumbar Region M1611 Unilateral Primary Osteoarthritis R51 Headache M1612 Unilateral Primary Osteoarthritis R109 Abdominal Pain M170 Bilateral Primary Osteoarthritis M25511 Right Shoulder Pain I480 Paraxysmal Atrial Fibrillation M25512 Left Shoulder Pain
9 D251 Intramural Leiomyoma Uterus M5412 Radiculopathy Cervical Region
10 Quarter Four, Arkansas statistics from 10/1/18 12/31/18 Family & General Practice Obstetrics & Gynecology Family & General Practice Medical Oncology Neurosurgery Physical Medicine & Rehabilitation Cardiovascular Surgery Nephrology Nephrology Top 10 IP s and Descriptions Approve Deny Total Top 10 OP s and Descriptions Approve Deny Total Description Description Initial Hospital Care Therapeutic Exercises Total Knee Replacement MRI of Lower Extremity Join w/o Obstetrical Care MRI Lumbar Spine w/o Total Hip Replacement MRI Brain Stem with and w/o Cesarean Delivery CT Thorax with Total Hysterectomy CT Abdomen & Pelvis w/contrast Laparoscopic Sleeve Gastrectomy MRI Neck Spine w/o Lumbar Spinal Fusion Combined MRI Upper Extremity Joint w/o Neck Spinal Fusion CT Abdomen & Pelvis Laparoscopic Gastric Bypass CT Abdomen & Pelvis w/o Contrast Top 10 IP s and Descriptions Approve Deny Total Top 10 OP s and Descriptions Approve Deny Total Description Description O80 Encounter Full Term Uncomplicated M545 Low Back Pain Pregnancy O82 Encounter for Cesarean Delivery M542 Cervicalgia M1712 Unilateral Primary Osteoarthritis M25561 Right Knee Pain M1711 Unilateral Primary Osteoarthritis M25562 Left Knee Pain E6601 Morbid Obesity M25511 Right Shoulder Pain M1611 Unilateral Primary Osteoarthritis R51 Headache M1612 Unilateral Primary Osteoarthritis R109 Abdominal Pain M5116 Disc Disorders with Radiculopathy M25512 Left Shoulder Pain C61 Malignant Neoplasm of Prostate M5416 Radiculopathy Lumbar Region M4316 Spondylolisthesis Lumbar M5412 Radiculopathy Cervical Region Back to Top
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