Prior Authorization

Workgroup Mission

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.