Payer and account strategy: where prior authorization is fast, where it stalls, and why.
-1pt
86%
Coverage approval rate
vs W13
Certified KPI
+3d
18days
Median time to coverage
vs W13
Certified KPI
+5pt
80%
Appeal overturn rate
2 pending · vs W13
Certified KPI
+3
43
PAs submitted (cum.)
vs W13
Certified KPI
PA approval rate trend
% approved of final adjudicated · W1–W14
Payer mix
% of hub-enrolled patients
46
enrolled
Commercial42%
Medicare32%
Medicaid18%
Other8%
Time-to-coverage distribution
Approved patients by days hub → coverage
Commercial15d median
Medicare17d median
Medicaid26d median
Other19d median
Top denial reasons
Initial denials to date
Appeals outcomes
7 appeals filed
Overturned4
Pending2
Upheld1
Most overturns followed resubmission with the FUS genetic report attached — the strongest lever for reducing time to coverage.