2026 UM Transparency Act Prior Authorization Report
Customize your policy alerts
Sign up for all CareSource Georgia policy alerts
Know when CareSource Georgia releases new policies or updates existing guidance.
Monitor payer policy activity
This document reports monthly outpatient prior authorization volumes, denial reasons, and turnaround time performance for CareSource Georgia's Georgia Marketplace. It affects administrative and utilization management stakeholders responsible for prior authorization processing and reporting.
No material clinical or coverage changes in this revision.
Report Contents and Metrics
Report contents
Report elements and metrics included
ALL of the following
Monthly volumes and status
- Monthly counts of outpatient prior authorization requests by status (Total and Denied), with month-level values and a year-to-date (YTD) total (e.g., YTD total requests = 923).YTD total = 923
Denial reason categories and counts
- Breakdown of outpatient prior authorization denials (Medical Benefit) by reason with month-level values and YTD totals for each category. Categories reported: Administrative (YTD = 5), Benefit Limit (YTD = 0), Exceeded Notification (YTD = 116), Medical Necessity Not Established / Limits (YTD = 615), Non-Participating (YTD = 162), Provider Not a Covered Benefit (YTD = 25), Other (YTD = 0).
Turnaround time performance
- Percentage of expedited and standard outpatient prior authorizations meeting required turnaround times, reported month-to-month with a YTD percent met: Expedited (YTD = 97.2%), Standard (YTD = 99.6%).
Code Listings
| No codes listed |
Monthly Volumes, Denials, and Turnaround Performance
Monthly outpatient prior authorization volumes and status
Monthly counts of outpatient prior authorization requests and their status are reported with month and year-to-date totals. The report shows monthly denied counts (e.g., Denied: Jan = 466; Feb = 457) and a year-to-date denied total of 923.
- Monthly denied counts provided (examples: Jan = 466; Feb = 457).
- Year-to-date denied total: 923.
Denial reason categories and counts
Denial reasons for medical-benefit outpatient prior authorizations are broken down by category with monthly and year-to-date counts. Categories include Administrative (YTD 5), Benefit Limit (YTD 0), Exceeded Notification (YTD 116), Medical Necessity Not Established (Limits) (YTD 615), Non-Participating (YTD 162), Provider Not a Covered Benefit (YTD 25), and Other (YTD 0).
- Administrative — YTD: 5
- Benefit Limit — YTD: 0
- Exceeded Notification — YTD: 116
- Medical Necessity Not Established (Limits) — YTD: 615
- Non-Participating — YTD: 162
- Provider Not a Covered Benefit — YTD: 25
- Other — YTD: 0
- Total YTD requests/denials: 923
Prior authorization turnaround time performance
Turnaround time performance for outpatient prior authorizations is reported as the percentage of decisions met within required timeframes for expedited and standard requests. Year-to-date performance: Expedited 97.2% met; Standard 99.6% met.
- Expedited turnaround time percent met — YTD: 97.2%
- Standard turnaround time percent met — YTD: 99.6%
Definitions and Reporting Notes
OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.