Prior Authorization Statistics Reporting and Criteria

The information below should not be considered your actual policy of insurance. It should be noted that not all of the services listed in the medical policies and criteria may be covered (included) under your existing policy. Please reference your plan or group policy for more specifics or Contact Health Alliance customer service if you have any questions.

• Health Alliance Medical and Pharmacy 2021 Data Statistics
• Health Alliance Medical and Pharmacy 2022 Data Statistics
• Health Alliance Medical and Pharmacy 2023 Data Statistics
• Health Alliance Medical and Pharmacy 2024 Data Statistics

*The statistics are applicable to Illinois state-regulated health issuers, but do not apply to employee or employer self-funded health plans (ERISA); healthcare provided under the Workers’ Compensation Act or the Workers Occupational Diseases Act; or state employee, local government, or school district health plans.

Prior Authorization (PA) Lists*

• 2021 DME List Standard (1/1/2021-12/31/2021)
• 2022 DME List Standard (1/1/2022-12/31/2022)
• 2023 DME List Standard (1/1/2023-12/31/2023)
• 2024 DME List Standard (1/1/2024-12/31/2024)
• 2025 DME List Standard (1/1/2025-12/31/2025)
• 2021 PA List Standard (1/1/2021-12/31/2021)
• 2022 PA List Standard (1/1/2022-12/31/2022)
• 2023 PA List Standard (1/1/2023-12/31/2023)
• 2024 PA List Standard (1/1/2024-12/31/2024)
• 2025 PA List Standard (1/1/2025-12/31/2025)

*The Prior Authorization (PA) lists are applicable to Illinois state-regulated health issuers, but do not apply to employee or employer self-funded health plans (ERISA); healthcare provided under the Workers’ Compensation Act or the Workers Occupational Diseases Act; or state employee, local government, or school district health plans. This information is current and posted as of January 1, 2025.

Appeals

If you have a complaint, or if you’re unhappy with coverage for care or a service being denied, in certain situations, you have the right to file an appeal to review the denial again.