File size: 23,322 Bytes
1155add | 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 176 177 178 179 180 181 182 183 184 185 186 187 188 189 190 191 192 193 194 195 196 197 198 199 200 201 202 203 204 205 206 207 208 209 | auth_id,member_id,auth_request_date,auth_decision_date,auth_turnaround_days,auth_procedure_category,auth_urgency,auth_decision,auth_denial_reason,auth_units_requested,auth_units_approved,peer_to_peer_requested,appeal_filed,appeal_outcome,clinical_criteria_met,payer_type
PA61969747,MBR00000001,2023-10-01,2023-10-02,1,Surgery,Urgent,Partial_Approval,Not Covered Benefit,2,0,0,1,Upheld,0,Commercial
PA33809187,MBR00000001,2023-11-05,2023-11-19,14,DME,Routine,Denied,Out-of-Network,1,0,0,0,,0,Commercial
PA80898745,MBR00000007,2023-03-12,2023-03-20,8,DME,Routine,Approved,,9,9,0,0,,1,Commercial
PA72926358,MBR00000007,2023-06-26,2023-06-29,3,Infusion Therapy,Routine,Approved,,3,3,0,0,,1,Commercial
PA42582943,MBR00000007,2023-08-01,2023-08-11,10,Infusion Therapy,Routine,Partial_Approval,Missing Documentation,3,1,0,1,Partial_Overturn,0,Commercial
PA45742549,MBR00000010,2023-04-29,2023-05-10,11,Transplant Evaluation,Routine,Approved,,11,11,0,0,,1,Medicare_Advantage
PA27583749,MBR00000014,2023-11-28,2023-12-12,14,Transplant Evaluation,Routine,Approved,,9,9,0,0,,1,Commercial
PA29159514,MBR00000014,2023-08-03,2023-08-17,14,DME,Routine,Denied,Step Therapy Not Completed,9,0,0,0,,0,Commercial
PA15959624,MBR00000014,2023-05-29,2023-06-01,3,Home Health,Routine,Approved,,1,1,0,0,,1,Commercial
PA24761842,MBR00000017,2023-04-10,2023-04-17,7,Cardiac Procedures,Routine,Approved,,4,4,0,0,,1,Commercial
PA67643572,MBR00000018,2023-07-25,2023-08-08,14,Chemotherapy,Routine,Approved,,3,3,0,0,,1,Commercial
PA18345100,MBR00000018,2023-07-31,2023-08-09,9,Orthopedic Procedures,Routine,Approved,,6,6,0,0,,1,Commercial
PA66152253,MBR00000022,2023-04-22,2023-04-25,3,DME,Urgent,Approved,,9,9,0,0,,1,Medicare_Advantage
PA41029671,MBR00000025,2023-08-29,2023-09-05,7,DME,Routine,Approved,,4,4,0,0,,1,Commercial
PA44325095,MBR00000027,2023-05-23,2023-06-03,11,Behavioral Health,Routine,Pending,,10,0,0,0,,0,Medicare_Advantage
PA24402696,MBR00000027,2023-05-19,2023-05-21,2,Behavioral Health,Emergency,Approved,,8,8,0,0,,1,Medicare_Advantage
PA58568144,MBR00000027,2023-03-10,2023-03-11,1,Infusion Therapy,Urgent,Approved,,3,3,0,0,,1,Medicare_Advantage
PA58555030,MBR00000028,2023-04-10,2023-04-17,7,Radiation Therapy,Routine,Approved,,10,10,0,0,,1,Commercial
PA30136391,MBR00000028,2023-01-12,2023-01-16,4,Transplant Evaluation,Routine,Approved,,11,11,0,0,,1,Commercial
PA47190970,MBR00000028,2023-06-25,2023-06-27,2,Orthopedic Procedures,Urgent,Approved,,11,11,0,0,,1,Commercial
PA20257352,MBR00000031,2023-08-10,2023-08-13,3,Bariatric Procedures,Urgent,Approved,,8,8,0,0,,1,Commercial
PA29153174,MBR00000033,2023-06-11,2023-06-19,8,Sleep Studies,Routine,Approved,,2,2,0,0,,1,Medicare_Advantage
PA86291306,MBR00000033,2023-04-02,2023-04-15,13,Transplant Evaluation,Routine,Approved,,4,4,0,0,,1,Medicare_Advantage
PA45798539,MBR00000033,2023-08-26,2023-09-02,7,DME,Routine,Partial_Approval,Step Therapy Not Completed,5,3,0,0,,0,Medicare_Advantage
PA17116756,MBR00000040,2023-01-23,2023-01-24,1,Neurology Services,Urgent,Approved,,7,7,0,0,,1,Medicare_Advantage
PA95387745,MBR00000041,2023-04-20,2023-04-22,2,Specialty Drugs,Urgent,Partial_Approval,Missing Documentation,2,1,0,1,Overturned,0,Commercial
PA49220569,MBR00000041,2023-08-20,2023-08-29,9,Surgery,Routine,Partial_Approval,Not Covered Benefit,1,0,0,0,,0,Commercial
PA38971913,MBR00000041,2023-07-03,2023-07-15,12,Specialty Imaging (MRI/CT),Routine,Approved,,5,5,0,0,,1,Commercial
PA25945775,MBR00000043,2023-12-18,2023-12-21,3,Genetic Testing,Routine,Approved,,11,11,0,0,,1,Commercial
PA23921600,MBR00000043,2023-10-06,2023-10-09,3,Physical Therapy Extended,Routine,Approved,,6,6,0,0,,1,Commercial
PA21677180,MBR00000043,2023-02-18,2023-02-28,10,Cardiac Procedures,Routine,Approved,,10,10,0,0,,1,Commercial
PA58273216,MBR00000045,2023-09-28,2023-10-08,10,Radiation Therapy,Routine,Approved,,9,9,0,0,,1,Commercial
PA13981364,MBR00000047,2023-01-30,2023-02-01,2,Infusion Therapy,Urgent,Approved,,11,11,0,0,,1,Commercial
PA96808740,MBR00000047,2023-08-04,2023-08-18,14,Skilled Nursing,Routine,Approved,,10,10,0,0,,1,Commercial
PA53876561,MBR00000050,2023-05-17,2023-05-18,1,DME,Emergency,Approved,,10,10,0,0,,1,Medicare_Advantage
PA69539398,MBR00000050,2023-05-12,2023-05-25,13,Infusion Therapy,Routine,Partial_Approval,Step Therapy Not Completed,1,0,0,0,,0,Medicare_Advantage
PA19865688,MBR00000050,2023-06-27,2023-07-07,10,Physical Therapy Extended,Routine,Approved,,2,2,0,0,,1,Medicare_Advantage
PA16090591,MBR00000053,2023-05-04,2023-05-18,14,Physical Therapy Extended,Routine,Partial_Approval,Step Therapy Not Completed,9,5,0,1,Overturned,0,Medicaid_MCO
PA14094605,MBR00000053,2023-04-09,2023-04-13,4,Specialty Drugs,Routine,Approved,,4,4,0,0,,1,Medicaid_MCO
PA45380195,MBR00000053,2023-11-28,2023-12-03,5,Specialty Drugs,Routine,Approved,,10,10,0,0,,1,Medicaid_MCO
PA72257682,MBR00000054,2023-05-28,2023-06-08,11,Chemotherapy,Routine,Pending,,10,0,0,0,,0,Medicare_Advantage
PA36984000,MBR00000054,2023-04-22,2023-04-27,5,Radiation Therapy,Routine,Approved,,4,4,0,0,,1,Medicare_Advantage
PA42382354,MBR00000057,2023-11-21,2023-11-24,3,Sleep Studies,Urgent,Approved,,4,4,0,0,,1,Medicare_Advantage
PA13288797,MBR00000057,2023-01-11,2023-01-20,9,Bariatric Procedures,Routine,Partial_Approval,Out-of-Network,10,5,0,0,,0,Medicare_Advantage
PA79415134,MBR00000059,2023-06-17,2023-06-21,4,Transplant Evaluation,Routine,Approved,,8,8,0,0,,1,Medicare_Advantage
PA62612918,MBR00000059,2023-03-02,2023-03-07,5,Surgery,Routine,Approved,,5,5,0,0,,1,Medicare_Advantage
PA18592761,MBR00000059,2023-05-22,2023-05-30,8,Skilled Nursing,Routine,Approved,,2,2,0,0,,1,Medicare_Advantage
PA93071425,MBR00000060,2023-05-06,2023-05-07,1,Cardiac Procedures,Urgent,Approved,,6,6,0,0,,1,ACA_Marketplace
PA22678551,MBR00000060,2023-03-08,2023-03-11,3,Bariatric Procedures,Routine,Denied,Out-of-Network,10,0,0,1,Upheld,0,ACA_Marketplace
PA81650538,MBR00000060,2023-02-09,2023-02-20,11,Genetic Testing,Routine,Denied,Medical Necessity,2,0,0,0,,0,ACA_Marketplace
PA48587456,MBR00000062,2023-05-12,2023-05-25,13,Home Health,Routine,Approved,,11,11,0,0,,1,Commercial
PA78125395,MBR00000062,2023-07-12,2023-07-19,7,Radiation Therapy,Routine,Approved,,5,5,0,0,,1,Commercial
PA28536547,MBR00000063,2023-11-10,2023-11-17,7,Cardiac Procedures,Routine,Approved,,3,3,0,0,,1,ACA_Marketplace
PA85276407,MBR00000065,2023-05-30,2023-06-06,7,Infusion Therapy,Routine,Approved,,2,2,0,0,,1,Commercial
PA19749040,MBR00000066,2023-10-24,2023-10-30,6,Sleep Studies,Routine,Approved,,2,2,0,0,,1,Medicaid_MCO
PA62445785,MBR00000072,2023-07-19,2023-07-27,8,Physical Therapy Extended,Routine,Approved,,2,2,0,0,,1,Medicare_Advantage
PA50293881,MBR00000074,2023-01-26,2023-02-06,11,Radiation Therapy,Routine,Approved,,8,8,0,0,,1,Medicare_Advantage
PA74840326,MBR00000074,2023-09-25,2023-09-27,2,Bariatric Procedures,Emergency,Approved,,9,9,0,0,,1,Medicare_Advantage
PA70988657,MBR00000075,2023-07-27,2023-07-30,3,Home Health,Urgent,Approved,,11,11,0,0,,1,Medicaid_MCO
PA36937980,MBR00000079,2023-09-09,2023-09-12,3,Specialty Drugs,Urgent,Approved,,8,8,0,0,,1,Medicaid_MCO
PA42280876,MBR00000080,2023-08-13,2023-08-19,6,Bariatric Procedures,Routine,Approved,,1,1,0,0,,1,Commercial
PA94882986,MBR00000080,2023-11-23,2023-12-06,13,Home Health,Routine,Approved,,3,3,0,0,,1,Commercial
PA85855182,MBR00000084,2023-07-06,2023-07-08,2,Radiation Therapy,Emergency,Approved,,4,4,0,0,,1,Medicare_Advantage
PA81103439,MBR00000085,2023-07-17,2023-07-18,1,Specialty Imaging (MRI/CT),Emergency,Approved,,2,2,0,0,,1,Medicare_Advantage
PA28862842,MBR00000085,2023-01-09,2023-01-11,2,Bariatric Procedures,Urgent,Approved,,8,8,0,0,,1,Medicare_Advantage
PA35250632,MBR00000088,2023-05-29,2023-05-31,2,Transplant Evaluation,Urgent,Approved,,11,11,0,0,,1,ACA_Marketplace
PA78772275,MBR00000088,2023-08-28,2023-09-03,6,Orthopedic Procedures,Routine,Approved,,11,11,0,0,,1,ACA_Marketplace
PA79753227,MBR00000088,2023-01-08,2023-01-18,10,Home Health,Routine,Approved,,8,8,0,0,,1,ACA_Marketplace
PA98791255,MBR00000089,2023-11-29,2023-12-13,14,Radiation Therapy,Routine,Pending,,2,0,0,0,,0,Commercial
PA27807007,MBR00000089,2023-06-27,2023-06-28,1,Genetic Testing,Emergency,Denied,Experimental/Investigational,8,0,0,0,,0,Commercial
PA68996806,MBR00000089,2023-07-15,2023-07-17,2,Radiation Therapy,Urgent,Approved,,7,7,0,0,,1,Commercial
PA45074934,MBR00000090,2023-01-17,2023-01-26,9,Genetic Testing,Routine,Approved,,4,4,0,0,,1,Medicare_Advantage
PA82168473,MBR00000091,2023-10-13,2023-10-20,7,DME,Routine,Approved,,5,5,0,0,,1,Commercial
PA81422380,MBR00000093,2023-06-11,2023-06-19,8,Specialty Imaging (MRI/CT),Routine,Approved,,2,2,0,0,,1,Medicare_Advantage
PA84791716,MBR00000093,2023-03-03,2023-03-06,3,Transplant Evaluation,Urgent,Approved,,7,7,0,0,,1,Medicare_Advantage
PA56246245,MBR00000098,2023-11-29,2023-12-05,6,Skilled Nursing,Routine,Approved,,9,9,0,0,,1,Medicare_Advantage
PA28632303,MBR00000098,2023-07-10,2023-07-24,14,Specialty Imaging (MRI/CT),Routine,Denied,Duplicate Request,7,0,0,1,Partial_Overturn,0,Medicare_Advantage
PA60099571,MBR00000098,2023-05-09,2023-05-12,3,Specialty Drugs,Routine,Approved,,9,9,0,0,,1,Medicare_Advantage
PA63886458,MBR00000099,2023-05-22,2023-06-02,11,DME,Routine,Approved,,7,7,0,0,,1,Commercial
PA32104986,MBR00000099,2023-12-01,2023-12-02,1,Neurology Services,Urgent,Approved,,4,4,0,0,,1,Commercial
PA55056956,MBR00000099,2023-04-15,2023-04-29,14,Chemotherapy,Routine,Approved,,7,7,0,0,,1,Commercial
PA24652994,MBR00000100,2023-12-19,2023-12-28,9,Skilled Nursing,Routine,Approved,,3,3,0,0,,1,ACA_Marketplace
PA97087245,MBR00000102,2023-06-23,2023-06-30,7,Neurology Services,Routine,Approved,,1,1,0,0,,1,Commercial
PA32253543,MBR00000102,2023-09-03,2023-09-14,11,Physical Therapy Extended,Routine,Approved,,3,3,0,0,,1,Commercial
PA13421788,MBR00000102,2023-11-19,2023-11-20,1,DME,Urgent,Approved,,7,7,0,0,,1,Commercial
PA20024477,MBR00000104,2023-03-29,2023-04-12,14,Behavioral Health,Routine,Approved,,1,1,0,0,,1,Medicaid_MCO
PA61458498,MBR00000104,2023-01-03,2023-01-17,14,Radiation Therapy,Routine,Approved,,11,11,0,0,,1,Medicaid_MCO
PA55387438,MBR00000104,2023-10-31,2023-11-11,11,Bariatric Procedures,Routine,Approved,,9,9,0,0,,1,Medicaid_MCO
PA64770671,MBR00000105,2023-05-06,2023-05-08,2,Neurology Services,Urgent,Approved,,3,3,0,0,,1,Commercial
PA82234429,MBR00000105,2023-02-21,2023-03-06,13,Chemotherapy,Routine,Approved,,9,9,0,0,,1,Commercial
PA90714148,MBR00000110,2023-04-18,2023-05-02,14,Radiation Therapy,Routine,Approved,,10,10,0,0,,1,Medicare_Advantage
PA47395221,MBR00000110,2023-06-12,2023-06-14,2,Transplant Evaluation,Urgent,Approved,,10,10,0,0,,1,Medicare_Advantage
PA27721752,MBR00000110,2023-10-08,2023-10-19,11,Radiation Therapy,Routine,Approved,,11,11,0,0,,1,Medicare_Advantage
PA49710487,MBR00000111,2023-12-02,2023-12-13,11,Home Health,Routine,Approved,,1,1,0,0,,1,Medicare_Advantage
PA65955662,MBR00000111,2023-01-04,2023-01-08,4,Radiation Therapy,Routine,Approved,,4,4,0,0,,1,Medicare_Advantage
PA10168736,MBR00000115,2023-07-07,2023-07-20,13,Physical Therapy Extended,Routine,Approved,,3,3,0,0,,1,Commercial
PA53755955,MBR00000117,2023-12-06,2023-12-16,10,Orthopedic Procedures,Routine,Approved,,5,5,0,0,,1,Medicaid_MCO
PA42120429,MBR00000117,2023-06-11,2023-06-17,6,Neurology Services,Routine,Approved,,9,9,0,0,,1,Medicaid_MCO
PA69284993,MBR00000123,2023-05-31,2023-06-13,13,Behavioral Health,Routine,Approved,,6,6,0,0,,1,ACA_Marketplace
PA36906198,MBR00000123,2023-05-07,2023-05-21,14,DME,Routine,Approved,,11,11,0,0,,1,ACA_Marketplace
PA77068841,MBR00000129,2023-08-19,2023-08-25,6,Cardiac Procedures,Routine,Approved,,3,3,0,0,,1,Medicare_Advantage
PA67852922,MBR00000135,2023-10-31,2023-11-03,3,Infusion Therapy,Routine,Approved,,9,9,0,0,,1,Commercial
PA44530159,MBR00000135,2023-08-31,2023-09-13,13,Skilled Nursing,Routine,Partial_Approval,Step Therapy Not Completed,8,2,0,1,Overturned,0,Commercial
PA86885928,MBR00000135,2023-04-17,2023-04-18,1,Specialty Imaging (MRI/CT),Urgent,Denied,Out-of-Network,5,0,0,0,,0,Commercial
PA67339365,MBR00000143,2023-06-12,2023-06-16,4,Physical Therapy Extended,Routine,Approved,,9,9,0,0,,1,Commercial
PA10996321,MBR00000143,2023-07-09,2023-07-13,4,Behavioral Health,Routine,Pending,,4,0,0,0,,0,Commercial
PA15165921,MBR00000143,2023-03-09,2023-03-15,6,Transplant Evaluation,Routine,Approved,,7,7,0,0,,1,Commercial
PA32296941,MBR00000144,2023-05-27,2023-06-04,8,Sleep Studies,Routine,Approved,,7,7,0,0,,1,Commercial
PA98170536,MBR00000146,2023-05-26,2023-05-30,4,Behavioral Health,Routine,Approved,,2,2,0,0,,1,Medicaid_MCO
PA69245013,MBR00000146,2023-06-23,2023-07-06,13,Skilled Nursing,Routine,Approved,,5,5,0,0,,1,Medicaid_MCO
PA35075941,MBR00000146,2023-11-23,2023-11-26,3,Bariatric Procedures,Urgent,Approved,,6,6,0,0,,1,Medicaid_MCO
PA51118984,MBR00000148,2023-06-24,2023-07-05,11,Genetic Testing,Routine,Denied,Medical Necessity,1,0,0,0,,0,Commercial
PA26405681,MBR00000148,2023-05-10,2023-05-14,4,Transplant Evaluation,Routine,Approved,,3,3,0,0,,1,Commercial
PA79857623,MBR00000150,2023-08-25,2023-09-05,11,Cardiac Procedures,Routine,Approved,,7,7,0,0,,1,Medicare_Advantage
PA37764654,MBR00000150,2023-11-02,2023-11-13,11,Cardiac Procedures,Routine,Approved,,2,2,0,0,,1,Medicare_Advantage
PA33089350,MBR00000150,2023-02-28,2023-03-01,1,Home Health,Urgent,Approved,,7,7,0,0,,1,Medicare_Advantage
PA11028619,MBR00000151,2023-08-26,2023-08-27,1,Specialty Drugs,Urgent,Approved,,3,3,0,0,,1,Medicare_Advantage
PA42265506,MBR00000153,2023-07-08,2023-07-12,4,Radiation Therapy,Routine,Approved,,3,3,0,0,,1,Commercial
PA54767153,MBR00000153,2023-03-16,2023-03-23,7,Infusion Therapy,Routine,Approved,,6,6,0,0,,1,Commercial
PA60840595,MBR00000154,2023-01-14,2023-01-19,5,Genetic Testing,Routine,Approved,,4,4,0,0,,1,Medicare_Advantage
PA44873411,MBR00000155,2023-10-05,2023-10-12,7,Skilled Nursing,Routine,Approved,,1,1,0,0,,1,ACA_Marketplace
PA62558931,MBR00000156,2023-01-20,2023-02-03,14,Home Health,Routine,Approved,,1,1,0,0,,1,Medicare_Advantage
PA85481565,MBR00000158,2023-09-14,2023-09-25,11,Specialty Drugs,Routine,Partial_Approval,Experimental/Investigational,2,0,0,0,,0,Commercial
PA19939809,MBR00000158,2023-03-20,2023-03-30,10,Sleep Studies,Routine,Approved,,5,5,0,0,,1,Commercial
PA16777357,MBR00000163,2023-04-07,2023-04-19,12,Neurology Services,Routine,Approved,,4,4,0,0,,1,Medicaid_MCO
PA67558296,MBR00000163,2023-05-23,2023-05-26,3,Cardiac Procedures,Routine,Approved,,9,9,0,0,,1,Medicaid_MCO
PA87173390,MBR00000163,2023-07-20,2023-07-31,11,Cardiac Procedures,Routine,Denied,Step Therapy Not Completed,6,0,0,0,,0,Medicaid_MCO
PA47252309,MBR00000166,2023-10-11,2023-10-14,3,DME,Urgent,Approved,,10,10,0,0,,1,ACA_Marketplace
PA28267218,MBR00000166,2023-04-06,2023-04-10,4,Chemotherapy,Routine,Approved,,5,5,0,0,,1,ACA_Marketplace
PA11243468,MBR00000171,2023-02-05,2023-02-09,4,Cardiac Procedures,Routine,Approved,,8,8,0,0,,1,Commercial
PA47931646,MBR00000171,2023-02-08,2023-02-10,2,Surgery,Emergency,Approved,,7,7,0,0,,1,Commercial
PA19261267,MBR00000175,2023-04-05,2023-04-19,14,Transplant Evaluation,Routine,Approved,,1,1,0,0,,1,Commercial
PA15997416,MBR00000175,2023-03-05,2023-03-09,4,Specialty Drugs,Routine,Denied,Coding Error,5,0,0,0,,0,Commercial
PA61395823,MBR00000175,2023-12-05,2023-12-13,8,DME,Routine,Approved,,8,8,0,0,,1,Commercial
PA17417156,MBR00000176,2023-08-21,2023-09-03,13,Cardiac Procedures,Routine,Denied,Coding Error,7,0,0,0,,0,Commercial
PA61990375,MBR00000176,2023-07-17,2023-07-25,8,Home Health,Routine,Approved,,6,6,0,0,,1,Commercial
PA36960315,MBR00000178,2023-05-25,2023-06-08,14,Sleep Studies,Routine,Approved,,4,4,0,0,,1,Medicaid_MCO
PA45447269,MBR00000179,2023-10-04,2023-10-16,12,DME,Routine,Approved,,1,1,0,0,,1,Medicare_Advantage
PA93465426,MBR00000182,2023-11-07,2023-11-09,2,Specialty Imaging (MRI/CT),Urgent,Approved,,11,11,0,0,,1,Commercial
PA96632885,MBR00000182,2023-07-28,2023-08-11,14,Surgery,Routine,Denied,Experimental/Investigational,9,0,0,0,,0,Commercial
PA44577100,MBR00000182,2023-02-01,2023-02-08,7,Orthopedic Procedures,Routine,Approved,,11,11,0,0,,1,Commercial
PA88826077,MBR00000186,2023-01-17,2023-01-19,2,Sleep Studies,Emergency,Approved,,8,8,0,0,,1,Commercial
PA11455891,MBR00000186,2023-01-23,2023-02-01,9,Orthopedic Procedures,Routine,Approved,,1,1,0,0,,1,Commercial
PA41311371,MBR00000187,2023-01-29,2023-02-04,6,Infusion Therapy,Routine,Approved,,9,9,0,0,,1,Medicaid_MCO
PA72499304,MBR00000187,2023-01-07,2023-01-12,5,Infusion Therapy,Routine,Approved,,10,10,0,0,,1,Medicaid_MCO
PA80091171,MBR00000189,2023-01-07,2023-01-09,2,Neurology Services,Urgent,Approved,,9,9,0,0,,1,Medicaid_MCO
PA97887024,MBR00000191,2023-04-07,2023-04-14,7,Infusion Therapy,Routine,Approved,,9,9,0,0,,1,Commercial
PA59239275,MBR00000203,2023-08-02,2023-08-03,1,Physical Therapy Extended,Urgent,Partial_Approval,Duplicate Request,3,2,0,1,Upheld,0,Commercial
PA63636454,MBR00000203,2023-01-09,2023-01-12,3,Physical Therapy Extended,Routine,Approved,,10,10,0,0,,1,Commercial
PA46316812,MBR00000210,2023-06-25,2023-07-05,10,Sleep Studies,Routine,Denied,Missing Documentation,1,0,0,1,Upheld,0,Medicare_Advantage
PA89169681,MBR00000210,2023-01-18,2023-01-29,11,Transplant Evaluation,Routine,Approved,,2,2,0,0,,1,Medicare_Advantage
PA94360897,MBR00000212,2023-10-10,2023-10-20,10,Specialty Drugs,Routine,Approved,,9,9,0,0,,1,Commercial
PA14300159,MBR00000213,2023-04-04,2023-04-14,10,Neurology Services,Routine,Approved,,4,4,0,0,,1,Commercial
PA17308787,MBR00000213,2023-09-07,2023-09-12,5,Radiation Therapy,Routine,Approved,,3,3,0,0,,1,Commercial
PA20777574,MBR00000213,2023-07-20,2023-07-25,5,Behavioral Health,Routine,Approved,,10,10,0,0,,1,Commercial
PA26984061,MBR00000214,2023-05-29,2023-06-01,3,Sleep Studies,Urgent,Approved,,4,4,0,0,,1,Commercial
PA31503043,MBR00000216,2023-11-18,2023-11-20,2,DME,Urgent,Approved,,8,8,0,0,,1,Medicare_Advantage
PA86532366,MBR00000216,2023-05-11,2023-05-17,6,Neurology Services,Routine,Approved,,7,7,0,0,,1,Medicare_Advantage
PA48817389,MBR00000216,2023-12-09,2023-12-15,6,Orthopedic Procedures,Routine,Approved,,3,3,0,0,,1,Medicare_Advantage
PA77263035,MBR00000220,2023-06-17,2023-06-24,7,Skilled Nursing,Routine,Approved,,1,1,0,0,,1,Commercial
PA49627102,MBR00000220,2023-08-07,2023-08-15,8,Specialty Imaging (MRI/CT),Routine,Partial_Approval,Coding Error,5,2,0,0,,0,Commercial
PA22721529,MBR00000220,2023-07-07,2023-07-10,3,Bariatric Procedures,Urgent,Partial_Approval,Duplicate Request,3,2,1,0,,0,Commercial
PA22533534,MBR00000221,2023-02-11,2023-02-17,6,Genetic Testing,Routine,Approved,,9,9,0,0,,1,Commercial
PA94953769,MBR00000232,2023-01-19,2023-01-26,7,DME,Routine,Approved,,5,5,0,0,,1,Medicaid_MCO
PA36561340,MBR00000232,2023-01-03,2023-01-12,9,Infusion Therapy,Routine,Partial_Approval,Step Therapy Not Completed,6,3,0,0,,0,Medicaid_MCO
PA10219535,MBR00000232,2023-08-14,2023-08-24,10,Transplant Evaluation,Routine,Approved,,3,3,0,0,,1,Medicaid_MCO
PA60164759,MBR00000233,2023-08-17,2023-08-24,7,Home Health,Routine,Approved,,5,5,0,0,,1,Medicare_Advantage
PA74947294,MBR00000233,2023-11-19,2023-11-27,8,Sleep Studies,Routine,Approved,,10,10,0,0,,1,Medicare_Advantage
PA15088321,MBR00000236,2023-02-15,2023-02-21,6,Chemotherapy,Routine,Approved,,3,3,0,0,,1,Medicaid_MCO
PA74908765,MBR00000236,2023-09-11,2023-09-23,12,Home Health,Routine,Approved,,6,6,0,0,,1,Medicaid_MCO
PA67482133,MBR00000236,2023-11-29,2023-12-11,12,Home Health,Routine,Approved,,6,6,0,0,,1,Medicaid_MCO
PA97908555,MBR00000238,2023-01-25,2023-01-28,3,Specialty Imaging (MRI/CT),Routine,Denied,Duplicate Request,2,0,1,0,,0,Commercial
PA48537522,MBR00000238,2023-10-18,2023-10-21,3,Sleep Studies,Urgent,Approved,,2,2,0,0,,1,Commercial
PA81122686,MBR00000238,2023-08-15,2023-08-16,1,Genetic Testing,Urgent,Approved,,3,3,0,0,,1,Commercial
PA69540151,MBR00000239,2023-01-04,2023-01-16,12,Orthopedic Procedures,Routine,Approved,,2,2,0,0,,1,Commercial
PA69075349,MBR00000242,2023-01-12,2023-01-25,13,Orthopedic Procedures,Routine,Denied,Step Therapy Not Completed,2,0,0,0,,0,Medicaid_MCO
PA29995074,MBR00000242,2023-08-18,2023-08-28,10,Radiation Therapy,Routine,Approved,,8,8,0,0,,1,Medicaid_MCO
PA37296988,MBR00000242,2023-04-03,2023-04-06,3,Cardiac Procedures,Urgent,Approved,,10,10,0,0,,1,Medicaid_MCO
PA57160799,MBR00000251,2023-03-17,2023-03-20,3,Surgery,Urgent,Approved,,7,7,0,0,,1,Commercial
PA40282067,MBR00000252,2023-07-03,2023-07-17,14,Home Health,Routine,Denied,Missing Documentation,6,0,0,0,,0,Medicare_Advantage
PA60460368,MBR00000252,2023-11-06,2023-11-13,7,Specialty Drugs,Routine,Approved,,3,3,0,0,,1,Medicare_Advantage
PA42835265,MBR00000256,2023-09-06,2023-09-16,10,DME,Routine,Approved,,6,6,0,0,,1,Commercial
PA18020327,MBR00000256,2023-05-25,2023-05-27,2,Skilled Nursing,Emergency,Approved,,5,5,0,0,,1,Commercial
PA62300332,MBR00000256,2023-01-08,2023-01-11,3,Chemotherapy,Urgent,Approved,,5,5,0,0,,1,Commercial
PA67288914,MBR00000258,2023-03-13,2023-03-27,14,Orthopedic Procedures,Routine,Approved,,11,11,0,0,,1,Commercial
PA59775438,MBR00000258,2023-11-20,2023-11-25,5,Skilled Nursing,Routine,Approved,,9,9,0,0,,1,Commercial
PA34300348,MBR00000263,2023-05-07,2023-05-18,11,Bariatric Procedures,Routine,Approved,,8,8,0,0,,1,Medicare_Advantage
PA29461446,MBR00000263,2023-01-25,2023-01-31,6,Cardiac Procedures,Routine,Approved,,3,3,0,0,,1,Medicare_Advantage
PA21388294,MBR00000275,2023-05-04,2023-05-16,12,Skilled Nursing,Routine,Approved,,11,11,0,0,,1,Medicare_Advantage
PA81406565,MBR00000275,2023-06-14,2023-06-27,13,Orthopedic Procedures,Routine,Approved,,2,2,0,0,,1,Medicare_Advantage
PA11239531,MBR00000279,2023-02-02,2023-02-12,10,Cardiac Procedures,Routine,Approved,,10,10,0,0,,1,Medicare_Advantage
PA93254423,MBR00000283,2023-08-22,2023-08-29,7,Surgery,Routine,Approved,,2,2,0,0,,1,Medicare_Advantage
PA30027012,MBR00000283,2023-10-18,2023-10-28,10,Infusion Therapy,Routine,Approved,,3,3,0,0,,1,Medicare_Advantage
PA97310419,MBR00000284,2023-05-14,2023-05-20,6,Transplant Evaluation,Routine,Approved,,3,3,0,0,,1,Medicaid_MCO
PA75726123,MBR00000286,2023-11-28,2023-12-09,11,Neurology Services,Routine,Approved,,4,4,0,0,,1,Medicare_Advantage
PA91843099,MBR00000286,2023-05-15,2023-05-16,1,Neurology Services,Emergency,Approved,,5,5,0,0,,1,Medicare_Advantage
PA15796072,MBR00000290,2023-06-03,2023-06-04,1,Sleep Studies,Urgent,Approved,,2,2,0,0,,1,Commercial
PA65674141,MBR00000290,2023-10-16,2023-10-29,13,Transplant Evaluation,Routine,Partial_Approval,Coding Error,10,7,0,0,,0,Commercial
PA41933908,MBR00000294,2023-08-04,2023-08-09,5,Specialty Imaging (MRI/CT),Routine,Approved,,8,8,0,0,,1,Medicare_Advantage
PA12639092,MBR00000295,2023-05-29,2023-06-01,3,Surgery,Routine,Approved,,1,1,0,0,,1,Commercial
PA54639221,MBR00000295,2023-10-14,2023-10-24,10,Physical Therapy Extended,Routine,Approved,,7,7,0,0,,1,Commercial
PA12857338,MBR00000295,2023-11-30,2023-12-03,3,Sleep Studies,Routine,Approved,,8,8,0,0,,1,Commercial
PA51639010,MBR00000298,2023-03-26,2023-03-29,3,Specialty Drugs,Routine,Approved,,5,5,0,0,,1,Medicaid_MCO
PA41102375,MBR00000298,2023-05-16,2023-05-23,7,Genetic Testing,Routine,Pending,,9,0,0,0,,0,Medicaid_MCO
PA14425193,MBR00000298,2023-11-19,2023-11-23,4,Behavioral Health,Routine,Approved,,2,2,0,0,,1,Medicaid_MCO
PA14193326,MBR00000300,2023-04-25,2023-04-26,1,Physical Therapy Extended,Urgent,Approved,,8,8,0,0,,1,Commercial
PA54210659,MBR00000300,2023-03-17,2023-03-24,7,Specialty Drugs,Routine,Approved,,10,10,0,0,,1,Commercial
|