Enhancing knowledge of authorization requests through registry development

Kara L. Kuntz-Melcavage, Kyle De Carlo Gahagan, Mark R. Fracasso, Jill A. Marsteller

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish (US)
Article numbere10050
JournalLearning Health Systems
Volume2
Issue number2
DOIs
StatePublished - Apr 2018

Keywords

  • bariatric
  • policy
  • registry
  • research
  • workflow

ASJC Scopus subject areas

  • Health Informatics
  • Public Health, Environmental and Occupational Health
  • Health Information Management

Fingerprint Dive into the research topics of 'Enhancing knowledge of authorization requests through registry development'. Together they form a unique fingerprint.

Cite this