TIER 2 · PRIOR AUTHORIZATION · ROI AUDIT SCORECARD
Your PA Program Has a Cost. Few Plans Measure It.
The Five-Metric Scorecard to Audit PA ROI.
A 2-page printable scorecard PBS uses across 100s of PBM contract reviews annually. Free download. Sent to your inbox.
Five-metric PA ROI rubric to score your program
Approval rate, turnaround, appeal-overturn, admin load, member abandonment
Traffic-light scoring: where PA adds value vs. friction
Optimization plan for the metrics scoring red
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A complete audit framework you can run in half a day.
WHAT IS IN THE WORKSHEET
PASS 03
Separate Value from Theater
A high appeal-overturn rate means the PA was denying care it should have approved. A high abandonment rate means members gave up at the counter. Both are PA doing harm, not control.
PASS 01
Score the Five Metrics
Run your PA program against the five-metric rubric: approval rate, turnaround time, appeal-overturn rate, administrative load, and member abandonment. Each scores green, yellow, or red.
PASS 02
Find the Friction
A high appeal-overturn rate means the PA was denying care it should have approved. A high abandonment rate means members gave up at the counter. Both are PA doing harm, not control.
ACTION PLAN
This Quarter's Action Plan
Score the program, flag the red metrics, and bring the documented friction points to your PBM. Require turnaround-time and overturn-rate reporting in the next contract cycle.