Prior Authorization Reporting

Prior authorization

Some medical services and treatments need to be approved by your health plan as "medically necessary" before you can get them. Your primary care provider (PCP) or other healthcare provider must get approval from your health plan — this is called “prior authorization.” This process helps make sure you get the care you need, as well as helping to stop fraud, waste, and abuse.

Centers for Medicare & Medicaid Services (CMS) requirement

Every year, AmeriHealth Caritas Ohio must provide data on our website about how many prior authorizations were submitted and approved or denied. The report must be posted by March 31. This reporting is part of CMS Interoperability and Prior Authorization Final Rule CMS-0057-F.

The Ohio Department of Medicaid (ODM) has directed that all Medicaid plans across the state must post information in a single, centralized location to comply with the requirements set by the Final Rule. Please refer to ODM’s website for access.