Group 3

Hamaspik Prior Authorization Data

2025 Calendar Year Data

Prior Authorization Information

Starting January 1, 2026, Managed Medicaid Care Plans (MMCPs) and Medicaid are required to share information about prior authorizations on their websites each year.

By March 31 of every year, plans will post data from the previous calendar year in a section of the website that is easy for the public to find and access.

This information will include details about how prior authorization requests were handled, helping members better understand how coverage decisions are made.

 These requirements apply to certain plan types, including Medicare Advantage and Medicaid Managed Care plans. For our organization, this includes D-SNP, MAP, and MLTC plans. 

 *The data is aggregated for all items and services. 

The following items provide the lists of codes requiring prior authorization for  our D-SNP, MAP, and MLTC Plans, as well as our prior authorization metrics for 2025.

See below downloadable prior auth code lists for MLTC, DSNP, and MAP.
 
MLTC CODE Prior authorization list-1

MLTC

Hamaspik Choice MLTC Prior Auth Codes

Download MLTC Prior Auth Code List
ChatGPT Image Apr 1, 2026, 11_24_12 AM

H0034 DSNP

Hamaspik Medicare Select (D-SNP) Prior Auth Codes

Download DSNP Prior Auth Code List
MAP Prior Auth List

H0034 MAP

Hamaspik Medicare Choice (MAP) Prior Auth Codes

Download MAP Prior Auth Code List

 Prior Auth Metrics

Prior Authorization Metrics MLTC

H0034 DSNP & MAP Medicare

 MAP Medicaid
• The percentage of standard prior authorization requests that were approved*. 51% 74% 48%
• The percentage of standard prior authorization requests that were denied*. 49% 26% 52%
• The percentage of standard prior authorization requests that were approved after appeal*. 15% 54% 8%
• The percentage of prior authorization requests for which the timeframe for review was extended, and the request was approved*. 15% 50% 9%
• The percentage of expedited prior authorization requests that were approved*. 84% 80% 0%
• The percentage of expedited prior authorization requests that were denied*. 16% 20% 0%
• The average time that elapsed between the submission of a request and a determination for standard prior authorizations*. (days) 7.59 3.55 7.84
• The median time that elapsed between the submission of a request and a determination for standard prior authorizations*. (days) 4.28 2 3.59
• The average time that elapsed between the submission of a request and decision for expedited prior authorizations*. (days) 4.22 1.57 0
• The median time that elapsed between the submission of a request and decision for expedited prior authorizations*. (days) 2.56 1 0
* Aggregated for all items and services.
 

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