§ 56-7-3717 — Statistics

A health carrier or utilization review organization requiring prior authorization shall make de-identified aggregate statistics available by service code regarding prior authorization approvals and denials on its website in a readily accessible format. The commissioner shall determine the information required in order to comply with this section and in accordance with applicable state and federal privacy laws. Such statistics include, but are not limited to: (1) The number of initial prior authorization requests that were approved or denied during the previous benefit plan year by the health carrier or utilization review organization; (2) The number of prior authorization requests that were appealed; (3) The number of appeals overturned and the number granted; (4) The time between submission of an initial prior authorization request and response; (5) The top five (5) reasons for denial; (6) The average time between submission and response for an initial prior authorization request; (7) The average time between submission and response for an appeal of a prior authorization denial; and (8) Any other information that the commissioner determines appropriate.

Legislative History

Amended by 2023 Tenn. Acts, ch. 395, s 4, eff. 1/1/2025.