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External Review Requests - Annual Statistics

  2010 2011 2012 2013
Total External Review Requests 13 30 45 39
         
Types of Review Requests:        
Standard 10 24 35 34
Urgent 3 6 10 5
         
Reasons for Review Requests:        
Medical Necessity 4 13 29 28
Investigational 9 16 16 8
Level of Care 0 1 0 0
         
Review Outcomes:        
Denials Overturned 2 10 20 9
Denials Upheld 8 14 15 21
Not Eligible for Review 3 6 10 9
         
Known Recoveries (Unknown) $284,821 $147,552 (Unknown)