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Prior Authorization

Prior authorization is a type of approval that is required for many services that are covered by Texas Medicaid and other State health-care programs.

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Prior Authorization Metrics

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The Centers for Medicare & Medicaid Services (CMS) requires that TMHP post specific prior authorization metrics. This includes metrics for approvals, denials, etc. for items and services that require prior authorization. Publicly reporting these metrics promotes transparency and accountability, helps patients understand prior authorization processes, and enables providers to evaluate payer performance. In addition, metrics can be used to compare plans, programs, and payers.

Access the TMHP Prior Authorization Report to access the past year's data.

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