Promote timely patient access to treatment by identifying and reducing administrative barriers and clinical concerns in the utilization management of Georgia Medicaid.
Durable Medical Equipment
OAPI FY 2022 – 2024 Strategic Goal 1: Enhancing Data Services.
OAPI FY 2022 – 2024 Strategic Goal: Relieving burdens for our stakeholders, providers, and members.
Durable Medical Equipment (DME) concerns raised include:
- Number of prior authorization denials for DME,
- Variations in the prior authorization process between CMOs for DME, and
- Transition of care issues when a member transitions from one CMO to another.
The goal here is to research the root of the discrepancies and identify a path toward minimizing them in the future. Goals include:
- Identify the reason behind discrepancies in the number of prior authorizations reported, including:
- Identifying and streamlining variations in CMO DME reporting.
- Identifying and streamlining variations in the processes and policies regarding which DME requires a PA and those that don’t.
Data displayed below give a visual of the differences in number of total claims submitted and breakdown of the claims by status.