Open AccessEnhancing knowledge of authorization requests through registry development
Author(s) -
KuntzMelcavage Kara L.,
Gahagan Kyle DeCarlo,
Fracasso Mark R.,
Marsteller Jill A.
Publication year - 2018
Publication title -
learning health systems
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.501
H-Index - 9
ISSN - 2379-6146
DOI - 10.1002/lrh2.10050
Subject(s) - authorization , population , test (biology) , business , realm , relevance (law) , health care , unit (ring theory) , workflow , medicine , medical emergency , family medicine , psychology , computer security , computer science , political science , environmental health , database , law , paleontology , mathematics education , biology
Understanding the member population to which medical coverage policies apply is important for ensuring the relevance of a health insurer's policies. The medical policy unit of our company developed a registry and workflow to enhance our knowledge about the members who seek authorization for bariatric surgery. Data captured in the registry have allowed us to construct a descriptive profile of the entire population that seeks bariatric surgery (both members who are approved and members who are denied). In addition, we have examined characteristics associated with denied authorization requests, determined the proportion of requests originating from specific insurance products, and studied the relationship between results on a specific laboratory test and authorization decisions. Given the growing importance of data in the realm of health care management, this article is an important demonstration of how data can be used to understand populations of members who are affected by medical policies.