Indiana 2025 Prior Authorization Statistics Form

Anthem Utilization Management Services Inc. 2025 Indiana Utilization Report

Anthem Utilization Management Services Inc. Total Initial Prior Authorization Requests 1,668

Total Approved 1,330

Total Denied 332

Total Pending 6 Denial Rate (%) 20% Average Time between Submission and Decision 2 Appeals 113

Appeals Approved 32

Appeals Denied 81

Appeals Pending

• Appeal Denial Rate (%) 72%
  Average Time between Submission and Decision for Appeals 2 Overall Prior Authorization Statistics

Rank by Count Taxonomy Code Healthcare Provider Specialty Requests Approved Denied Pending Average Days to Initial Decision 1 Surgery 271 234 67 0 4.7 2 General Medicine (Family Med, Internal Med, Peds, Hospitalist) 103 73 30 3 2.45 3 Other 86 48 38 0 3 4 Hospital (acute care, rehab, etc) 84 70 13 0 1.5 5 Otolaryngology 71 62 9 0 2.5 6 OB GYN (Nurse Midwife) 67 41 26 0 2.25 7 Ophthalmology 61 61 0 0 2.2 8 Oncology / Hematology 55 46 9 0 1.6 9 Nurse Practitioner 44 31 13 0 3.6 10 Urology 28 21 7 0 2.91 Most Approved Rank by Count Taxonomy Code Healthcare Provider Specialty Requests Approved Denied Pending Average Days to Initial Decision 1 Surgery 271 234 67 0 4.7 2 General Medicine (Family Med, Internal Med, Peds, Hospitalist) 103 73 30 3 2.45 3 Hospital (acute care, rehab, etc) 84 70 13 0 1.5 4 Otolaryngology 71 62 9 0 2.5 5 Ophthalmology 61 61 0 0 2.2 6 Other 86 48 38 0 3 7 Oncology / Hematology 55 46 9 0 1.6 8 OB GYN (Nurse Midwife) 67 41 26 0 2.25 9 Nurse Practitioner 44 31 13 0 3.6 10 Physical Med & Rehab 23 23 0 0 4.3 Most Denied Rank by Count Taxonomy Code Healthcare Provider Specialty Requests Approved Denied Pending Average Days to Initial Decision 1 Surgery 271 234 67 0 4.7 2 Other 86 48 38 0 3 3 General Medicine (Family Med, Internal Med, Peds, Hospitalist) 103 73 30 3 2.45 4 OB GYN (Nurse Midwife) 67 41 26 0 2.25 5 Hospital (acute care, rehab, etc) 84 70 13 0 1.5 6 Nurse Practitioner 44 31 13 0 3.6 7 Otolaryngology 71 62 9 0 2.5 8 Oncology / Hematology 55 46 9 0 1.6 9 Urology 28 21 7 0 2.91 10 Durable Medical Equipment & Medical Supplies 18 11 7 5.36 Anthem Utilization Management Services Inc. Top 10 Taxonomies Ranked by Count of Prior Authorization Requests/Approvals/Denials: Most Requested

Rank by Count Medication RxCUI (RxNorm) (IN or MIN concept) Requests Approved Denied Pending Average Days to Initial Decision 1 INJECTION ERTAPENEM SODIUM 500 MG 7 7 0 1.6 2 HYALURONAN/DERIVATIVE EUFLEXXA IA INJ PER DOSE J7323 3 1 2 0 1.3 3 INTRAVITREAL NJX PHARMACOLOGIC AGT SPX 67028 3 3 0 0 1 4 IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST TO 1 HR 96365 3 3 0 0 1.4 5 INJECTION ZOLEDRONIC ACID 1 MG J3489 2 1 0 1 1 6 Injection, vancomycin HCl, 10 mg 2 2 0 1 7 Injections 62327 1 1 1.5 8 CHEMOTX ADMN CNS REQ SPINAL PUNCTURE 96450 1 1 0 0 0 9 HYALURONAN/DERIV ORTHOVISC IA INJ PER DOSE 1 1 1 10 HYALURONAN/DERIV SYNVISC/SYNVISC- ONE IA INJ 1 MG J7325 1 0 1 0 1 Most Approved Rank by Count Medication RxCUI (RxNorm) (IN or MIN concept) Requests Approved Denied Pending Average Days to Initial Decision 1 INJECTION ERTAPENEM SODIUM 500 MG 7 7 0 1.6 2 INTRAVITREAL NJX PHARMACOLOGIC AGT SPX 67028 3 3 0 0 1 3 IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST TO 1 HR 96365 3 3 0 0 1.4 4 Injection, vancomycin HCl, 10 mg 2 2 0 1 5 HYALURONAN/DERIVATIVE EUFLEXXA IA INJ PER DOSE J7323 3 1 2 0 1.3 6 INJECTION ZOLEDRONIC ACID 1 MG J3489 2 1 0 1 1 7 CHEMOTX ADMN CNS REQ SPINAL PUNCTURE 96450 1 1 0 0 0 8 Injection cefazolin sodium 250 MG 1 1 1 9 Injection cefazolin sodium 500MG 1 1 1 10 INJECTION CEFTRIAXONE SODIUM PER 250 MG 1 1 0 1 Most Denied Rank by Count Medication RxCUI (RxNorm) (IN or MIN concept) Requests Approved Denied Pending Average Days to Initial Decision 1 HYALURONAN/DERIVATIVE EUFLEXXA IA INJ PER DOSE J7323 3 1 2 0 1.3 2 HYALURONAN/DERIV SYNVISC/SYNVISC- ONE IA INJ 1 MG J7325 1 0 1 0 1 3 HYALURONAN/DERIVATIVE DUROLANE FOR IA INJ 1 MG 1 0 1 1 4 HYALURONAN/DERIVATIVE GELSYN-3 FOR IA INJ 0.1 MG J7328 1 0 1 0 1 5 Injections 62327 1 1 1.5 6 HYALURONAN/DERIV ORTHOVISC IA INJ PER DOSE 1 1 1 7 INJECTION ERTAPENEM SODIUM 500 MG 7 7 0 1.6 8 INTRAVITREAL NJX PHARMACOLOGIC AGT SPX 67028 3 3 0 0 1 9 IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST TO 1 HR 96365 3 3 0 0 1.4 10 Injection, vancomycin HCl, 10 mg 2 2 0 1 Anthem Utilization Management Services Inc. Top 10 Medications by Count of Prior Authorization Requests/Approvals/Denials: Most Requested

Rank by Count Diagnostic Test or Procedure Procedure Code Code Type (CPT, DRG,…) Requests Approved Denied Pending Average Days to Initial Decision 1 Other 256 22 234 1.3 2 Office other OP consult 99244 90 32 58 1.25 3 Hereditary breast cancer-related disorders (eg, hereditary breast cancer, hereditary ovarian cancer, hereditary endometrial cancer, hereditary pancreatic cancer, hereditary prostate cancer), genomic sequence analysis panel, 5 or more genes, interrogation for sequence variants and copy number variants 81432 44 32 12 0 1.6 4 CFTR (cystic fibrosis transmembrane conductance regulator) (eg, cystic fibrosis) gene analysis common variants (eg, ACMG/ACOG guidelines) 81443 35 4 30 1 1.5 5 Automatic Enternal Difibulator K0606 18 10 8 1 6 Unlisted molecular pathology procedure 0340U 18 2 16 0 2.3 7 Exome (eg, unexplained constitutional or heritable disorder or syndrome) sequence analysis 81479 12 9 3 0 1.5 8 Oncology (breast), mRNA, gene expression profiling by real- time RT-PCR of 21 genes, utilizing formalin-fixed paraffin embedded tissue, algorithm reported as recurrence score 81220 10 10 0 0 1 9 Liver transplant 47135 CPT 9 9 0 0 4.3 10 Intravitreal injection of a pharmacologic agent (separate procedure) 67028 CPT 8 8 0 1 Most Approved Rank by Count Diagnostic Test or Procedure Procedure Code Code Type (CPT, DRG,…) Requests Approved Denied Pending Average Days to Initial Decision 1 Office other OP consult 99244 90 32 58 1.25 2 Hereditary breast cancer-related disorders (eg, hereditary breast cancer, hereditary ovarian cancer, hereditary endometrial cancer, hereditary pancreatic cancer, hereditary prostate cancer), genomic sequence analysis panel, 5 or more genes, interrogation for sequence variants and copy number variants 81432 44 32 12 0 1.6 3 Other 256 22 234 1.3 4 Automatic Enternal Difibulator K0606 18 10 8 1 5 Oncology (breast), mRNA, gene expression profiling by real- time RT-PCR of 21 genes, utilizing formalin-fixed paraffin embedded tissue, algorithm reported as recurrence score 81220 10 10 0 0 1 6 Exome (eg, unexplained constitutional or heritable disorder or syndrome) sequence analysis 81479 12 9 3 0 1.5 7 Liver transplant 47135 CPT 9 9 0 0 4.3 8 Intravitreal injection of a pharmacologic agent (separate procedure) 67028 CPT 8 8 0 1 9 Hematopoietic progenitor cell (HPC) autologous transplantation 38241 CPT 7 7 0 0 2.6 10 Genetic testing for severe inherited conditions (eg, cystic fibrosis, Ashkenazi Jewish-associated disorders [eg, Bloom syndrome, Canavan disease, Fanconi anemia type C, mucolipidosis type VI, Gaucher disease, Tay-Sachs disease], beta hemoglobinopathies, phenylketonuria, galactosemia), genomic sequence analysis panel, must include sequencing of at least 15 genes (eg, ACADM, ARSA, ASPA, ATP7B, BCKDHA, BCKDHB, BLM, CFTR, DHCR7, FANCC, G6PC, GAA, GALT, GBA, GBE1, HBB, HEXA, IKBKAP, MCOLN1, PAH) 81415 6 6 0 0 1.2 Anthem Utilization Management Services Inc. Top 10 Diagnostic Tests by Count of Prior Authorization Requests/Approvals/Denials: Most Requested

Anthem Utilization Management Services Inc. Most Denied Rank by Count Diagnostic Test or Procedure Procedure Code Code Type (CPT, DRG,…) Requests Approved Denied Pending Average Days to Initial Decision 1 Other 256 22 234 1.3 2 Office other OP consult 99244 90 32 58 1.25 3 CFTR (cystic fibrosis transmembrane conductance regulator) (eg, cystic fibrosis) gene analysis common variants (eg, ACMG/ACOG guidelines) 81443 35 4 30 1 1.5 4 Unlisted molecular pathology procedure 0340U 18 2 16 0 2.3 5 Hereditary breast cancer-related disorders (eg, hereditary breast cancer, hereditary ovarian cancer, hereditary endometrial cancer, hereditary pancreatic cancer, hereditary prostate cancer), genomic sequence analysis panel, 5 or more genes, interrogation for sequence variants and copy number variants 81432 44 32 12 0 1.6 6 Automatic Enternal Difibulator K0606 18 10 8 1 7 Gastroenterology (Barrett's esophagus), whole slide-digital imaging, including morphometric analysis, computer- assisted quantitative immunolabeling of 9 protein biomarkers (p16, AMACR, p53, CD68, COX-2, CD45RO, HIF1a, HER-2, K20) and morphology, formalin-fixed paraffin- embedded tissue, algorithm reported as risk of progression to high-grade dysplasia or cancer 0108U CPT 6 0 6 1.33 8 Cytogenomic (genome-wide) analysis for constitutional chromosomal abnormalities interrogation of genomic regions for copy number and single nucleotide polymorphism (SNP) variants, comparative genomic hybridization (CGH) microarray analysis 81542 6 2 4 0 3 9 Exome (eg, unexplained constitutional or heritable disorder or syndrome) sequence analysis 81479 12 9 3 0 1.5 10 UNLISTED PROCEDURE DENTOALVEOLAR STRUCTURES 41899 CPT 5 3 2 1.7

Rank by Count Medical Indication Requests Approved Denied Pending Average Days to Initial Decision 1 Neoplasms (C00-D49) 253 192 61 0 10.07 2 Factors influencing health status and contact with health services (Z00-Z99) 168 119 45 2 2.8 3 Diseases of the circulatory system (I00-I99) 131 124 6 1 4.32 4 Diseases of the musculoskeletal system and connective tissue (M00-M99) 88 70 20 0 3.58 5 Endocrine, nutritional and metabolic diseases (E00-E89) 75 75 0 0 1.5 6 Diseases of the digestive system (K00-K95) 73 66 7 0 7.2 7 Diseases of the genitourinary system (N00-N99) 68 59 9 0 6.1 8 Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99) 49 44 5 0 2.82 9 Diseases of the respiratory system (J00-J99) 45 45 0 0 2.2 10 Diseases of the eye and adnexa (H00-H59) 42 40 2 0 2.61 Most Approved Rank by Count Medical Indication Requests Approved Denied Pending Average Days to Initial Decision 1 Neoplasms (C00-D49) 253 192 61 0 10.07 2 Diseases of the circulatory system (I00-I99) 131 124 6 1 4.32 3 Factors influencing health status and contact with health services (Z00-Z99) 168 119 45 2 2.8 4 Endocrine, nutritional and metabolic diseases (E00-E89) 75 75 0 0 1.5 5 Diseases of the musculoskeletal system and connective tissue (M00-M99) 88 70 20 0 3.58 6 Diseases of the digestive system (K00-K95) 73 66 7 0 7.2 7 Diseases of the genitourinary system (N00-N99) 68 59 9 0 6.1 8 Diseases of the respiratory system (J00-J99) 45 45 0 0 2.2 9 Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99) 49 44 5 0 2.82 10 Diseases of the eye and adnexa (H00-H59) 42 40 2 0 2.61 Most Denied Rank by Count Medical Indication Requests Approved Denied Pending Average Days to Initial Decision 1 Neoplasms (C00-D49) 253 192 61 0 10.07 2 Factors influencing health status and contact with health services (Z00-Z99) 168 119 45 2 2.8 3 Certain infectious and parasitic diseases (A00-B99) 24 1 23 1.3 4 Diseases of the musculoskeletal system and connective tissue (M00-M99) 88 70 20 0 3.58 5 Diseases of the genitourinary system (N00-N99) 68 59 9 0 6.1 6 Diseases of the digestive system (K00-K95) 73 66 7 0 7.2 7 Diseases of the circulatory system (I00-I99) 131 124 6 1 4.32 8 Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99) 49 44 5 0 2.82 9 Diseases of the nervous system (G00-G99) 15 12 3 0 2.07 10 Diseases of the eye and adnexa (H00-H59) 42 40 2 0 2.61 Anthem Utilization Management Services Inc. Top 10 Indications by Count of Prior Authorization Requests/Approvals/Denials: Most Requested *A medical indication is a condition, sign, or symptom indicating the need for care.

Rank by Count Reason for Denial Denials Appeals Appeals Approved Appeals Denied Appeals Pending Average Days for a
Decision upon Appeal 1 Not Medically Necessary 151 63 14 49 0 2.3 2 NMN - Network Provider Available 102 24 1 23 0 2 3 Insufficient Information Received 34 1 1 0 0 4 4 Non-Covered Services 20 2 0 2 0 1.5 5 Investigational and Not Medically Necessary 18 10 4 6 0 1.8 6 Investigational 4 n/a 7 Re-review upheld 2 n/a 8 Cosmetic 1 n/a 9 Other 13 13 12 1 0 1.6 10 11 12 13 14 15 16 17 18 19 20 Anthem Utilization Management Services Inc. Top 20 Reasons for Denial by Count of Prior Authorizations Denied:

Carelon Medical Benefit Management & Clinical Program Authorization Services 2025 Indiana Utilization Report

Carelon Medical Benefit Management Clinical Program Authorization Services Total Initial Prior Authorization Requests 171,075 Total Approved 157,508 Total Denied 13,567 Total Pending N/A Denial Rate (%) 7.9% Average Time between Submission and Decision 3.28 Appeals 52 Appeals Approved 25 Appeals Denied 27 Appeals Pending N/A Appeal Denial Rate (%) 51.9% Average Time between Submission and Decision for Appeals 8.1 Overall Prior Authorization Statistics

Rank by Count Taxonomy Code Healthcare Provider Specialty (Requesting Provider) Requests Approved Denied Pending Average Days to Initial Decision 1 Nurse/ Nurse Practitioner 20,547 18,915 1,632 4.20 2 Family Practice 18,660 16,942 1,718 4.49 3 Miscellaneous 16,476 15,129 1,347 3.07 4 Orthopedic Surgery 15,378 14,111 1,267 5.99 5 Internal Medicine 12,805 11,651 1,154 2.20 6 Pediatrics 8,282 8,019 263 4.64 7 Cardiovascular Diseases 6,625 6,289 336 0.16 8 Pain Management 5,247 4,604 643 1.66 9 Adolescent Medicine 5,194 4,827 367 3.40 10 Gastroenterology 5,025 4,838 187 0.19 Most Approved Rank by Count Taxonomy Code Healthcare Provider Specialty Requests Approved Denied Pending Average Days to Initial Decision 1 Nurse/ Nurse Practitioner 20,547 18,915 1,632 4.20 2 Family Practice 18,660 16,942 1,718 4.49 3 Miscellaneous 16,476 15,129 1,347 3.07 4 Orthopedic Surgery 15,376 14,112 1,264 5.99 5 Internal Medicine 12,805 11,651 1,154 2.20 6 Pediatrics 8,282 8,019 263 4.64 7 Cardiovascular Diseases 6,625 6,289 336 0.16 8 Gastroenterology 5,025 4,838 187 0.19 9 Adolescent Medicine 5,194 4,827 367 3.40 10 Pain Management 5,247 4,604 643 1.66 Most Denied Rank by Count Taxonomy Code Healthcare Provider Specialty Requests Approved Denied Pending Average Days to Initial Decision 1 Family Practice 18,660 16,942 1,718 4.49 2 Nurse/ Nurse Practitioner 20,554 18,920 1,634 4.20 3 Miscellaneous 16,476 15,129 1,347 3.07 4 Orthopedic Surgery 15,378 14,111 1,267 5.99 5 Internal Medicine 12,805 11,651 1,154 2.20 6 Pain Management 5,247 4,604 643 1.66 7 Physical Medicine & Rehabilitation 4,317 3,931 386 4.45 8 Anesthesiology 3,084 2,700 384 1.44 9 Adolescent Medicine 5,194 4,827 367 3.40 10 Chiropractic 3,744 3,397 347 2.29 Carelon Medical Benefit Management Clinical Program Authorization Services Top 10 Taxonomies Ranked by Count of Prior Authorization Requests/Approvals/Denials: Most Requested

Rank by Count Medication RxCUI (RxNorm) (IN or MIN concept) Requests Approved Denied Pending Average Days to Initial Decision 1 N/A 2 N/A 3 N/A 4 N/A 5 N/A 6 N/A 7 N/A 8 N/A 9 N/A 10 N/A Most Approved Rank by Count Medication RxCUI (RxNorm) (IN or MIN concept) Requests Approved Denied Pending Average Days to Initial Decision 1 N/A 2 N/A 3 N/A 4 N/A 5 N/A 6 N/A 7 N/A 8 N/A 9 N/A 10 N/A Most Denied Rank by Count Medication RxCUI (RxNorm) (IN or MIN concept) Requests Approved Denied Pending Average Days to Initial Decision 1 N/A 2 N/A 3 N/A 4 N/A 5 N/A 6 N/A 7 N/A 8 N/A 9 N/A 10 N/A Carelon Medical Benefit Management Clinical Program Authorization Services Top 10 Medications by Count of Prior Authorization Requests/Approvals/Denials: Most Requested

Rank by Count Diagnostic Test or Procedure Procedure Code Code Type (CPT, DRG,…) Requests Approved Denied Pending Average Days to Initial Decision 1 THERAPEUTIC EXERCISE TO DEVELOP STRENGTH, ENDURANCE, RANGE OF MOTION, AND FLEXIBILITY, EACH 15 MINUTES 97110 CPT 35,681 33,664 2,017 2.90 2 MANUAL (PHYSICAL) THERAPY TECHNIQUES TO 1 OR MORE REGIONS, EACH 15 MINUTES 97140 CPT 29,889 28,114 1,775 3.00 3 THERAPEUTIC ACTIVITIES TO IMPROVE FUNCTION, WITH ONE-ON-ONE CONTACT BETWEEN PATIENT AND PROVIDER, EA 97530 CPT 28,829 27,319 1,510 3.35 4 THERAPEUTIC PROCEDURE TO RE- EDUCATE BRAIN-TO-NERVE-TO-MUSCLE FUNCTION, EACH 15 MINUTES 97112 CPT 25,824 24,393 1,431 3.27 5 SELF-CARE OR HOME MANAGEMENT TRAINING, EACH 15 MINUTES 97535 CPT 10,967 10,376 591 3.18 6 WALKING TRAINING TO 1 OR MORE AREAS, EACH 15 MINUTES 97116 CPT 10,633 10,094 539 3.25 7 ECHO, transthoracic w/doppler, complete 93306 CPT 9,861 9,716 145 0.06 8 TREATMENT OF SPEECH, LANGUAGE, VOICE, COMMUNICATION, AND/OR HEARING PROCESSING DISORDER 92507 CPT 6,057 5,831 226 3.75 9 MRI of lumbar spine 72148 CPT 5,420 4,887 533 0.17 10 CT ABD & PELVIS W/CONTRAST 74177 CPT 4,788 4,538 250 0.11 Most Approved Rank by Count Diagnostic Test or Procedure Procedure Code Code Type (CPT, DRG,…) Requests Approved Denied Pending Average Days to Initial Decision 1 THERAPEUTIC EXERCISE TO DEVELOP STRENGTH, ENDURANCE, RANGE OF MOTION, AND FLEXIBILITY, EACH 15 MINUTES 97110 CPT 35,681 33,664 2,017 2.90 2 MANUAL (PHYSICAL) THERAPY TECHNIQUES TO 1 OR MORE REGIONS, EACH 15 MINUTES 97140 CPT 29,889 28,114 1,775 3.00 3 THERAPEUTIC ACTIVITIES TO IMPROVE FUNCTION, WITH ONE-ON-ONE CONTACT BETWEEN PATIENT AND PROVIDER, EA 97530 CPT 28,829 27,319 1,510 3.35 4 THERAPEUTIC PROCEDURE TO RE- EDUCATE BRAIN-TO-NERVE-TO-MUSCLE FUNCTION, EACH 15 MINUTES 97112 CPT 25,824 24,393 1,431 3.27 5 SELF-CARE OR HOME MANAGEMENT TRAINING, EACH 15 MINUTES 97535 CPT 10,967 10,376 591 3.18 6 WALKING TRAINING TO 1 OR MORE AREAS, EACH 15 MINUTES 97116 CPT 10,633 10,094 539 3.25 7 ECHO, transthoracic w/doppler, complete 93306 CPT 9,861 9,716 145 0.06 8 TREATMENT OF SPEECH, LANGUAGE, VOICE, COMMUNICATION, AND/OR HEARING PROCESSING DISORDER 92507 CPT 6,057 5,831 226 3.75 9 MRI of lumbar spine 72148 CPT 5,420 4,887 533 0.17 10 CT ABD & PELVIS W/CONTRAST 74177 CPT 4,788 4,538 250 0.11 Carelon Medical Benefit Management Clinical Program Authorization Services Top 10 Diagnostic Tests by Count of Prior Authorization Requests/Approvals/Denials: Most Requested

Carelon Medical Benefit Management Clinical Program Authorization Services Most Denied Rank by Count Diagnostic Test or Procedure Procedure Code Code Type (CPT, DRG,…) Requests Approved Denied Pending Average Days to Initial Decision 1 THERAPEUTIC EXERCISE TO DEVELOP STRENGTH, ENDURANCE, RANGE OF MOTION, AND FLEXIBILITY, EACH 15 MINUT 97110 CPT 35,681 33,664 2,017 2.90 2 MANUAL (PHYSICAL) THERAPY TECHNIQUES TO 1 OR MORE REGIONS, EACH 15 MINUTES 97140 CPT 29,889 28,114 1,775 3.00 3 THERAPEUTIC ACTIVITIES TO IMPROVE FUNCTION, WITH ONE-ON-ONE CONTACT BETWEEN PATIENT AND PROVIDER, EA 97530 CPT 28,829 27,319 1,510 3.35 4 THERAPEUTIC PROCEDURE TO RE- EDUCATE BRAIN-TO-NERVE-TO-MUSCLE FUNCTION, EACH 15 MINUTES 97112 CPT 25,824 24,393 1,431 3.27 5 POLYSOM 6/> YRS 4/> PARAM 95810 CPT 469 424 45 0.40 6 Polysomnography; Age 6 years or older, sleep staging with 4 or more additional parameters of sleep, attended by a technologist 95810 CPT 3,106 2,465 641 0.41 7 SELF-CARE OR HOME MANAGEMENT TRAINING, EACH 15 MINUTES 97535 CPT 10,967 10,376 591 3.18 8 INJECT SI JOINT ARTHRGRPHY&/ANES/STEROID W/IMA 27096 CPT 1,214 632 582 0.44 9 WALKING TRAINING TO 1 OR MORE AREAS, EACH 15 MINUTES 97116 CPT 10,633 10,094 539 3.25 10 MRI of lumbar spine 72148 CPT 5,420 4,887 533 0.17 11 MRI, lower extremity any joint; wo contr 73721 CPT 4,336 4,025 315 0.12

Rank by Count Medical Indication Requests Approved Denied Pending Average Days to Initial Decision 1 G47.33 11,871 10,827 1,044 0.20 2 M54.16 3,884 3,686 206 0.11 3 R69 3,728 3,202 533 0.22 4 R07.9 3,000 2,895 109 0.09 5 Z12.11 2,600 2,573 30 0.05 6 M47.816 2,523 2,361 167 0.13 7 M54.50 2,389 2,260 129 10.21 8 M54.2 1,973 1,834 140 14.64 9 M54.12 1,727 1,648 83 0.12 10 R91.1 1,605 1,509 96 0.14 Most Approved Rank by Count Medical Indication Requests Approved Denied Pending Average Days to Initial Decision 1 G47.33 11,871 10,827 1,044 0.20 2 M54.16 3,884 3,686 206 0.11 3 R69 3,728 3,202 533 0.22 4 R07.9 3,000 2,895 109 0.09 5 Z12.11 2,600 2,573 30 0.05 6 M47.816 2,523 2,361 167 0.13 7 M54.50 2,389 2,260 129 10.21 8 M54.2 1,973 1,834 140 14.64 9 M54.12 1,727 1,648 83 0.12 10 R91.1 1,605 1,509 96 0.14 Most Denied Rank by Count Medical Indication Requests Approved Denied Pending Average Days to Initial Decision 1 G47.33 11,871 10,827 1,044 0.20 2 R69 3,728 3,202 533 0.22 3 M46.1 1,036 557 482 0.45 4 M54.16 3,884 3,686 206 0.11 5 M47.816 2,523 2,361 167 0.13 6 M54.2 1,973 1,834 140 14.64 7 M54.50 921 795 129 0.25 8 M54.50 2,389 2,260 129 10.21 9 R10.9 1,347 1,225 125 0.15 10 Z80.3 284 165 119 1.94 Carelon Medical Benefit Management Clinical Program Authorization Services Top 10 Indications by Count of Prior Authorization Requests/Approvals/Denials: Most Requested *A medical indication is a condition, sign, or symptom indicating the need for care.

Rank by Count Reason for Denial Denials Appeals Appeals Approved Appeals Denied Appeals Pending Average Days for a
Decision upon Appeal 1 Criteria Not Met 9,808 N/A N/A N/A N/A N/A 2 Criteria Not Met-Site of Care 1,554 N/A N/A N/A N/A N/A 3 PCCA-Criteria Not Met 469 N/A N/A N/A N/A N/A 4 Reconsideration 331 N/A N/A N/A N/A N/A 5 Lack of Medical Necessity 224 36 17 19 N/A 6.1 6 Provider Documentation Review 110 N/A N/A N/A N/A N/A 7 Health Plan Medical Policy 67 N/A N/A N/A N/A N/A 8 Reconsideration Upheld 61 13 8 5 0 10.7 9 Health Plan Program Limitation 48 N/A N/A N/A N/A N/A 10 CRITERIA NOT MET – SITE OF CARE 20 N/A N/A N/A N/A N/A 11 PCCA- Health Plan Medical Policy 8 N/A N/A N/A N/A N/A 12 Criteria Not Met - Level of Care 3 N/A N/A N/A N/A N/A 13 No Member Benefit 3 N/A N/A N/A N/A N/A 14 Intent to Deny 3 3 0 3 0 20.7 15 Lack of Clinical Information 3 0 0 0 0 0 16 NMN-Network Provider Available 1 0 0 0 0 0 17 Out of Network 1 0 0 0 0 0 18 Criteria Not Met - CE 1 N/A N/A N/A N/A N/A 19 HEALTH PLAN MEDICAL POLICY 1 N/A N/A N/A N/A N/A 20 PCCA- HEALTH PLAN MEDICAL POLICY 1 N/A N/A N/A N/A N/A Carelon Medical Benefit Management Clinical Program Authorization Services Top 20 Reasons for Denial by Count of Prior Authorizations Denied:

Carelon Behavioral Health 2025 Indiana Utilization Report

Carelon Behavioral Health Total Initial Prior Authorization Requests 976 Total Approved 881 Total Denied 95 Total Pending 0 Denial Rate (%) 9.7% Average Time between Submission and Decision 1.10 Appeals n/a Appeals Approved n/a Appeals Denied n/a Appeals Pending n/a Appeal Denial Rate (%) n/a Average Time between Submission and Decision for Appeals n/a Overall Prior Authorization Statistics

Carelon Behavioral Health Most Requested Rank by Count Taxonomy Code Healthcare Provider Specialty Requests Approved Denied Pending Average Days to Initial Decision 1 Applied Behavioral Analyst 98 86 12 0 2 2 Psychiatry 67 60 7 0 1.1 3 Substance Use Disorder Rehab Hospital Unit 37 36 1 0 3 4 Addiction Medicine 35 34 1 0 1.1 5 Behavior Health Grp 26 19 7 0 2 6 Hospital, Acute Care 21 14 7 0 1 7 Substance Abuse Rehabilitation Facility 18 18 0 0 1 8 Family Medicine & Osteopathic Manipulative Treatme 17 17 0 0 1 9 Multi-Specialty Group 15 15 0 0 1 10 Outpatient Psych/Substance Abuse Center 15 15 0 0 1 Most Approved Rank by Count Taxonomy Code Healthcare Provider Specialty Requests Approved Denied Pending Average Days to Initial Decision 1 Applied Behavioral Analyst 98 86 12 0 2 2 Psychiatry 67 60 7 0 1.1 3 Substance Use Disorder Rehab Hospital Unit 37 36 1 0 3 4 Addiction Medicine 35 34 1 0 1.1 5 Behavior Health Grp 26 19 7 0 2 6 Hospital, Acute Care 21 14 7 0 1 7 Substance Abuse Rehabilitation Facility 18 18 0 0 1 8 Family Medicine & Osteopathic Manipulative Treatment 17 17 0 0 1 9 Multi-Specialty Group 15 15 0 0 1 10 Outpatient Psych/Substance Abuse Center 15 15 0 0 1 Most Denied Rank by Count Taxonomy Code Healthcare Provider Specialty Requests Approved Denied Pending Average Days to Initial Decision 1 Applied Behavioral Analyst 98 86 12 0 2 2 Psychiatry 67 60 7 0 1.1 3 Behavior Health Grp 26 19 7 0 2 4 Hospital, Acute Care 21 14 7 0 1 5 Substance Use Disorder Rehab Hospital Unit 37 36 1 0 3 6 Addiction Medicine 35 34 1 0 1.1 7 Substance Abuse Rehabilitation Facility 18 18 0 0 1 8 Family Medicine & Osteopathic Manipulative Treatme 17 17 0 0 1 9 Multi-Specialty Group 15 15 0 0 1 10 Outpatient Psych/Substance Abuse Center 15 15 0 0 1 Top 10 Taxonomies Ranked by Count of Prior Authorization Requests/Approvals/Denials:

Carelon Behavioral Health Most Requested Rank by Count Medication RxCUI (RxNorm) (IN or MIN concept) Requests Approved Denied Pending Average Days to Initial Decision 1 2 3 4 5 6 7 8 9 10 Most Denied Rank by Count Medication RxCUI (RxNorm) (IN or MIN concept) Requests Approved Denied Pending Average Days to Initial Decision 1 2 3 4 5 6 7 8 9 10 Most Denied Rank by Count Medication RxCUI (RxNorm) (IN or MIN concept) Requests Approved Denied Pending Average Days to Initial Decision 1 2 3 4 5 6 7 8 9 10 Top 10 Medications by Count of Prior Authorization Requests/Approvals/Denials:

Carelon Behavioral Health Most Requested Rank by Count Diagnostic Test or Procedure Procedure Code Code Type (CPT, DRG,…) Requests Approved Denied Pending Average Days to Initial Decision 1 out-patient professional 900 Rev 382 316 66 3.2 2 Intensive out- patient H0015 CPT 313 295 18 3.1 3 Partial Hospitalization H0035 CPT 281 270 11 3.2 4 5 6 7 8 9 10 Most Denied Rank by Count Diagnostic Test or Procedure Procedure Code Code Type (CPT, DRG,…) Requests Approved Denied Pending Average Days to Initial Decision 1 out-patient professional 900 Rev 382 316 66 3.2 2 Intensive out- patient H0015 CPT 313 295 18 3.1 3 Partial Hospitalization H0035 CPT 281 270 11 3.2 4 5 6 7 8 9 10 Most Denied Rank by Count Diagnostic Test or Procedure Procedure Code Code Type (CPT, DRG,…) Requests Approved Denied Pending Average Days to Initial Decision 1 out-patient professional 900 Rev 382 316 66 3.2 2 Intensive out- patient H0015 CPT 313 295 18 3.1 3 Partial Hospitalization H0035 CPT 281 270 11 3.2 4 5 6 7 8 9 10 Top 10 Diagnostic Tests by Count of Prior Authorization Requests/Approvals/Denials:

Carelon Behavioral Health Most Requested Rank by Count Medical Indication Requests Approved Denied Pending Average Days to Initial Decision 1 F10.20 Alcohol dependence, uncomplicated 233 221 12 0 1.5 2 F84.0 AUTISTIC DISORDER 232 199 33 0 3.2 3 F33.2 Major depressive disorder, recurrent severe without psychotic features 101 90 11 0 2 4 F15.20 Other stimulant dependence, uncomplicated 86 77 9 0 1.5 5 F11.20 Opioid dependence, uncomplicated 67 60 7 0 2 6 F33.1 Major depressive disorder, recurrent, moderate 30 26 4 0 1.2 7 F14.20 Cocaine dependence, uncomplicated 26 25 1 0 1.1 8 F41.1 GENERALIZED ANXIETY DISORDER 23 20 3 0 1.1 9 F50.89 Other specified eating disorder 11 11 0 0 1 10 F12.20 Cannabis dependence, uncomplicated 10 9 1 0 1 Most Denied Rank by Count Medical Indication Requests Approved Denied Pending Average Days to Initial Decision 1 F10.20 Alcohol dependence, uncomplicated 233 221 12 0 1.5 2 F84.0 AUTISTIC DISORDER 232 199 33 0 3.2 3 F33.2 Major depressive disorder, recurrent severe without psychotic features 101 90 11 0 2 4 F15.20 Other stimulant dependence, uncomplicated 86 77 9 0 1.5 5 F11.20 Opioid dependence, uncomplicated 67 60 7 0 2 6 F33.1 Major depressive disorder, recurrent, moderate 30 26 4 0 1.2 7 F14.20 Cocaine dependence, uncomplicated 26 25 1 0 1.1 8 F41.1 GENERALIZED ANXIETY DISORDER 23 20 3 0 1.1 9 F50.89 Other specified eating disorder 11 11 0 0 1 10 F12.20 Cannabis dependence, uncomplicated 10 9 1 0 1 Most Denied Rank by Count Medical Indication Requests Approved Denied Pending Average Days to Initial Decision 1 F84.0 AUTISTIC DISORDER 232 199 33 0 3.2 2 F10.20 Alcohol dependence, uncomplicated 233 221 12 0 1.5 3 F33.2 Major depressive disorder, recurrent severe without psychotic features 101 90 11 0 2 4 F15.20 Other stimulant dependence, uncomplicated 86 77 9 0 1.5 5 F11.20 Opioid dependence, uncomplicated 67 60 7 0 2 6 F33.1 Major depressive disorder, recurrent, moderate 30 26 4 0 1.2 7 F41.1 GENERALIZED ANXIETY DISORDER 23 20 3 0 1.1 8 F14.20 Cocaine dependence, uncomplicated 26 25 1 0 1.1 9 F12.20 Cannabis dependence, uncomplicated 10 9 1 0 1 10 F50.89 Other specified eating disorder 11 11 0 0 1 *A medical indication is a condition, sign, or symptom indicating the need for care. Top 10 Indications by Count of Prior Authorization Requests/Approvals/Denials:

Carelon Behavioral Health Rank by Count Reason for Denial Denials Appeals Appeals Approved Appeals Denied Appeals Pending Average Days for a
Decision upon Appeal 1 Not medically necessary, appropriate, effective, or efficient 43 2 Not being provided in or at an appropriate health care setting or level of care 52 3 Experimental or investigational 0 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Top 20 Reasons for Denial by Count of Prior Authorizations Denied:

Carelon Global Solutions - Puerto Rico 2025 Indiana Utilization Report

Carelon Global Solutions - Puerto Rico Total Initial Prior Authorization Requests Total Approved Total Denied Total Pending Denial Rate (%) Average Time between Submission and Decision Appeals Appeals Approved Appeals Denied Appeals Pending Appeal Denial Rate (%) Average Time between Submission and Decision for Appeals Overall Prior Authorization Statistics Data is not available at this time. The number of cases is minimal, and will be reported with the 2026 data.

Carelon Global Solutions - Puerto Rico Most Requested Rank by Count Taxonomy Code Healthcare Provider Specialty Requests Approved Denied Pending Average Days to Initial Decision 1 2 3 4 5 6 7 8 9 10 Most Approved Rank by Count Taxonomy Code Healthcare Provider Specialty Requests Approved Denied Pending Average Days to Initial Decision 1 2 3 4 5 6 7 8 9 10 Most Denied Rank by Count Taxonomy Code Healthcare Provider Specialty Requests Approved Denied Pending Average Days to Initial Decision 1 2 3 4 5 6 7 8 9 10 Top 10 Taxonomies Ranked by Count of Prior Authorization Requests/Approvals/Denials:

Carelon Global Solutions - Puerto Rico Most Requested Rank by Count Medication RxCUI (RxNorm) (IN or MIN concept) Requests Approved Denied Pending Average Days to Initial Decision 1 2 3 4 5 6 7 8 9 10 Most Approved Rank by Count Medication RxCUI (RxNorm) (IN or MIN concept) Requests Approved Denied Pending Average Days to Initial Decision 1 2 3 4 5 6 7 8 9 10 Most Denied Rank by Count Medication RxCUI (RxNorm) (IN or MIN concept) Requests Approved Denied Pending Average Days to Initial Decision 1 2 3 4 5 6 7 8 9 10 Top 10 Medications by Count of Prior Authorization Requests/Approvals/Denials:

Carelon Global Solutions - Puerto Rico Most Requested Rank by Count Diagnostic Test or Procedure Procedure Code Code Type (CPT, DRG,…) Requests Approved Denied Pending Average Days to Initial Decision 1 2 3 4 5 6 7 8 9 10 Most Approved Rank by Count Diagnostic Test or Procedure Procedure Code Code Type (CPT, DRG,…) Requests Approved Denied Pending Average Days to Initial Decision 1 2 3 4 5 6 7 8 9 10 Most Denied Rank by Count Diagnostic Test or Procedure Procedure Code Code Type (CPT, DRG,…) Requests Approved Denied Pending Average Days to Initial Decision 1 2 3 4 5 6 7 8 9 10 Top 10 Diagnostic Tests by Count of Prior Authorization Requests/Approvals/Denials:

Carelon Global Solutions - Puerto Rico Most Requested Rank by Count Medical Indication Requests Approved Denied Pending Average Days to Initial Decision 1 2 3 4 5 6 7 8 9 10 Most Approved Rank by Count Medical Indication Requests Approved Denied Pending Average Days to Initial Decision 1 2 3 4 5 6 7 8 9 10 Most Denied Rank by Count Medical Indication Requests Approved Denied Pending Average Days to Initial Decision 1 2 3 4 5 6 7 8 9 10 *A medical indication is a condition, sign, or symptom indicating the need for care. Top 10 Indications by Count of Prior Authorization Requests/Approvals/Denials:

Carelon Global Solutions - Puerto Rico Rank by Count Reason for Denial Denials Appeals Appeals Approved Appeals Denied Appeals Pending Average Days for a
Decision upon Appeal 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Top 20 Reasons for Denial by Count of Prior Authorizations Denied:

Carelon Global Solutions - Philippines 2025 Indiana Utilization Report

Carelon Global Solutions - Philippines Total Initial Prior Authorization Requests 1,291 Total Approved 1,146 Total Denied 144 Total Pending 1 Denial Rate (%) 11% Average Time between Submission and Decision 1.31 Appeals n/a Appeals Approved n/a Appeals Denied n/a Appeals Pending n/a Appeal Denial Rate (%) n/a Average Time between Submission and Decision for Appeals n/a Overall Prior Authorization Statistics

Carelon Global Solutions - Philippines Most Requested Rank by Count Taxonomy Code Healthcare Provider Specialty Requests Approved Denied Pending Average Days to Initial Decision 1 Surgery, General 170 163 7 0 2 Obstetrics & Gynecology 95 90 5 0 3 Other 74 62 12 0 4 Surgery, Plastic 66 62 4 0 5 Hospital, Acute Care 61 53 8 0 6 Otolaryngology 60 54 6 0 7 Internal Medicine 46 37 9 0 8 Surgery, Neurological 42 41 1 0 9 Surgery, Thoracic 35 35 0 0 10 Surgery, Colon & Rectal Surgery 35 34 0 1 Most Approved Rank by Count Taxonomy Code Healthcare Provider Specialty Requests Approved Denied Pending Average Days to Initial Decision 1 Surgery, General 163 2 Obstetrics & Gynecology 90 3 Other 62 4 Surgery, Plastic 62 5 Otolaryngology 54 6 Hospital, Acute Care 53 7 Surgery, Neurological 41 8 Internal Medicine 37 9 Surgery, Thoracic 35 10 Surgery, Colon & Rectal Surgery 34 Most Denied Rank by Count Taxonomy Code Healthcare Provider Specialty Requests Approved Denied Pending Average Days to Initial Decision 1 Other 12 2 Internal Medicine 9 3 Hospital, Acute Care 8 4 Nurse Practitioner 8 5 Surgery, General 7 6 Otolaryngology 6 7 Obstetrics & Gynecology 5 8 Urology 5 9 Surgery, Orthopedic 5 10 Surgery, Plastic 4 Top 10 Taxonomies by Count of Prior Authorization Requests/Approvals/Denials:

Carelon Global Solutions - Philippines Most Requested Rank by Count Medication RxCUI (RxNorm) (IN or MIN concept) Requests Approved Denied Pending Average Days to Initial Decision 1 Other 8 8 0 0 2 Chemotherapy 4 4 0 0 3 Vincristine sulfate, 1 mg 3 3 0 0 4 INJECTION CEFTRIAXONE SODIUM PER 250 MG 3 3 0 0 5 Injection, methotrexate sodium, 50 mg 3 3 0 0 6 HYALURONAN/DERIV SYNVISC/SYNVISC‑ONE IA INJ 1 MG 3 1 2 0 7 IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST TO 1 HR 2 2 0 0 8 INTRAVITREAL NJX PHARMACOLOGIC AGT SPX 2 2 0 0 9 Injection, fludarabine phosphate, 50 mg 2 2 0 0 10 HIT ABX ANTIVIRAL/ANTIFUNGAL TX Q24 HRS DIEM 2 2 0 0 Most Approved Rank by Count Medication RxCUI (RxNorm) (IN or MIN concept) Requests Approved Denied Pending Average Days to Initial Decision 1 Other 8 2 Chemotherapy 4 3 Vincristine sulfate, 1 mg 3 4 INJECTION CEFTRIAXONE SODIUM PER 250 MG 3 5 Injection, methotrexate sodium, 50 mg 3 6 IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST TO 1 HR 2 7 INTRAVITREAL NJX PHARMACOLOGIC AGT SPX 2 8 Injection, fludarabine phosphate, 50 mg 2 9 HIT ABX ANTIVIRAL/ANTIFUNGAL TX Q24 HRS DIEM 2 10 HYALURONAN/DERIV SYNVISC/SYNVISC‑ONE IA INJ 1 MG 1 Top 10 Medications by Count of Prior Authorization Requests/Approvals/Denials:

Carelon Global Solutions - Philippines Most Denied Rank by Count Medication RxCUI (RxNorm) (IN or MIN concept) Requests Approved Denied Pending Average Days to Initial Decision 1 HYALURONAN/DERIV SYNVISC/SYNVISC‑ONE IA INJ 1 MG 2 2 HYALURONAN/DERIVATIVE EUFLEXXA IA INJ PER DOSE 2 3 HYALURONAN/DERIVATIVE GELSYN‑3 FOR IA INJ 0.1 MG 2 4 5 6 7 8 9 10

Carelon Global Solutions - Philippines Most Requested Rank by Count Diagnostic Test or Procedure Procedure Code Code Type (CPT, DRG,…) Requests Approved Denied Pending Average Days to Initial Decision 1 Immunoassay for analyte other than infectious agent antibody or infectious agent antigen quantitative, not otherwise specified 83520 CPT 18 9 9 2 Immunoassay for analyte other than infectious agent antibody or infectious agent antigen qualitative or semiquantitative, multiple step method 83516 CPT 9 7 2 3 Genetic testing for severe inherited conditions (eg, cystic fibrosis, Ashkenazi Jewish-associated disorders [eg, Bloom syndrome, Canavan disease, Fanconi anemia type C, mucolipidosis type VI, Gaucher disease, Tay-Sachs disease], beta hemoglobinopathies, phenylketonuria, galactosemia), genomic sequence analysis panel, must include sequencing of at least 15 genes (eg, ACADM, ARSA, ASPA, ATP7B, BCKDHA, BCKDHB, BLM, CFTR, DHCR7, FANCC, G6PC, GAA, GALT, GBA, GBE1, HBB, HEXA, IKBKAP, MCOLN1, PAH) 81443 CPT 3 1 2 4 HEREDITARY BRST CA-RLATD DO GEN SEQ ALYS 5+ GEN 81432 CPT 2 1 1 5 ONCOLOGY PROSTATE BIOCHEMICAL ASSAY 4 PROTEINS 81539 CPT 2 0 2 6 MYOCRD STRAIN IMG SPECKLE TRCK ASSMT MYOCRD MECH 93356 CPT 2 0 2 7 LIVER DIS 10 ASSAYS SERUM ALGORITHM W/NASH 0003M CPT 1 0 1 8 Neurology (Alzheimer disease), beta amyloid (AB40, AB42, AB42/40 ratio) and tau-protein (pTau217, np-tau217, pTau217/np-tau217 ratio), blood, immunoprecipitation with quantitation by liquid chromatography with tandem mass spectrometry (LC-MS/MS), algorithm score reported as likelihood of positive or negative for amyloid plaques 0503U CPT 1 1 0 9 ADJT TIS TRNSFR/REARRGMT E/N/E/L DFCT 10 SQ CM/< 14060 CPT 1 1 0 10 Magnetic resonance image guided high intensity focused ultrasound (MRgFUS), stereotactic ablation of target, intracranial, including stereotactic navigation and frame placement, when performed 61715 CPT 1 1 0 Most Approved Rank by Count Diagnostic Test or Procedure Procedure Code Code Type (CPT, DRG,…) Requests Approved Denied Pending Average Days to Initial Decision 1 Immunoassay for analyte other than infectious agent antibody or infectious agent antigen quantitative, not otherwise specified 83520 CPT 9 2 Immunoassay for analyte other than infectious agent antibody or infectious agent antigen qualitative or semiquantitative, multiple step method 83516 CPT 7 3 Genetic testing for severe inherited conditions (eg, cystic fibrosis, Ashkenazi Jewish-associated disorders [eg, Bloom syndrome, Canavan disease, Fanconi anemia type C, mucolipidosis type VI, Gaucher disease, Tay-Sachs disease], beta hemoglobinopathies, phenylketonuria, galactosemia), genomic sequence analysis panel, must include sequencing of at least 15 genes (eg, ACADM, ARSA, ASPA, ATP7B, BCKDHA, BCKDHB, BLM, CFTR, DHCR7, FANCC, G6PC, GAA, GALT, GBA, GBE1, HBB, HEXA, IKBKAP, MCOLN1, PAH) 81443 CPT 1 4 HEREDITARY BRST CA-RLATD DO GEN SEQ ALYS 5+ GEN 81432 CPT 1 5 Neurology (Alzheimer disease), beta amyloid (AB40, AB42, AB42/40 ratio) and tau-protein (pTau217, np-tau217, pTau217/np-tau217 ratio), blood, immunoprecipitation with quantitation by liquid chromatography with tandem mass spectrometry (LC-MS/MS), algorithm score reported as likelihood of positive or negative for amyloid plaques 0503U CPT 1 6 ADJT TIS TRNSFR/REARRGMT E/N/E/L DFCT 10 SQ CM/< 14060 CPT 1 Top 10 Diagnostic Tests by Count of Prior Authorization Requests/Approvals/Denials:

Carelon Global Solutions - Philippines Rank by Count Diagnostic Test or Procedure Procedure Code Code Type (CPT, DRG,…) Requests Approved Denied Pending Average Days to Initial Decision 7 Magnetic resonance image guided high intensity focused ultrasound (MRgFUS), stereotactic ablation of target, intracranial, including stereotactic navigation and frame placement, when performed 61715 CPT 1 8 Computed tomography, thorax, diagnostic with contrast material(s) 71260 CPT 1 9 AORTIC DYSFUNCTION/DILATION GENOMIC SEQ ANALYSIS 81410 CPT 1 10 EEG COMPLETE STD PHYS/QHP>60 HR<84 HR W/VEEG 95724 CPT 1 Most Denied Rank by Count Diagnostic Test or Procedure Procedure Code Code Type (CPT, DRG,…) Requests Approved Denied Pending Average Days to Initial Decision 1 Immunoassay for analyte other than infectious agent antibody or infectious agent antigen quantitative, not otherwise specified 83520 CPT 9 2 Immunoassay for analyte other than infectious agent antibody or infectious agent antigen qualitative or semiquantitative, multiple step method 83516 CPT 2 3 Genetic testing for severe inherited conditions (eg, cystic fibrosis, Ashkenazi Jewish-associated disorders [eg, Bloom syndrome, Canavan disease, Fanconi anemia type C, mucolipidosis type VI, Gaucher disease, Tay-Sachs disease], beta hemoglobinopathies, phenylketonuria, galactosemia), genomic sequence analysis panel, must include sequencing of at least 15 genes (eg, ACADM, ARSA, ASPA, ATP7B, BCKDHA, BCKDHB, BLM, CFTR, DHCR7, FANCC, G6PC, GAA, GALT, GBA, GBE1, HBB, HEXA, IKBKAP, MCOLN1, PAH) 81443 CPT 2 4 ONCOLOGY PROSTATE BIOCHEMICAL ASSAY 4 PROTEINS 81539 CPT 2 5 MYOCRD STRAIN IMG SPECKLE TRCK ASSMT MYOCRD MECH 93356 CPT 2 6 HEREDITARY BRST CA-RLATD DO GEN SEQ ALYS 5+ GEN 81432 CPT 1 7 LIVER DIS 10 ASSAYS SERUM ALGORITHM W/NASH 0003M CPT 1 8 CT MAXILLOFACIAL W/O CONTRAST MATERIAL 70486 CPT 1 9 MRI UPPER EXTREM OTHER THAN JT W/O & W/CONTRAS 73220 CPT 1 10 SO/HEMATOLYMPHOID NEO/DO 51/>RNA ANALYSIS 81456 CPT 1

Carelon Global Solutions - Philippines Most Requested Rank by Count Medical Indication* Requests Approved Denied Pending Average Days to Initial Decision 1 Personal history of malignant neoplasm of breast 18 18 0 0 2 BASAL CELL CARCINOMA OF SKIN OF NOSE 15 15 0 0 3 DEVIATED NASAL SEPTUM 14 11 3 0 4 Atherosclerotic heart disease of native coronary artery without angina pectoris 13 12 1 0 5 Colostomy status 12 12 0 0 6 Acquired absence of bilateral breasts and nipples 11 11 0 0 7 MALIGNANT NEOPLASM OF RECTUM 11 11 0 0 8 Nonrheumatic mitral (valve) insufficiency 11 10 1 0 9 Malignant neoplasm of colon, unspecified 10 10 0 0 10 Diverticulitis of intestine, part unspecified, without perforation or abscess without bleeding 9 9 0 0 Most Approved Rank by Count Medical Indication Requests Approved Denied Pending Average Days to Initial Decision 1 Personal history of malignant neoplasm of breast 18 2 BASAL CELL CARCINOMA OF SKIN OF NOSE 15 3 Atherosclerotic heart disease of native coronary artery without angina pectoris 12 4 Colostomy status 12 5 DEVIATED NASAL SEPTUM 11 6 Acquired absence of bilateral breasts and nipples 11 7 MALIGNANT NEOPLASM OF RECTUM 11 8 Nonrheumatic mitral (valve) insufficiency 10 9 Malignant neoplasm of colon, unspecified 10 10 Diverticulitis of intestine, part unspecified, without perforation or abscess without bleeding 9 Most Denied Rank by Count Medical Indication Requests Approved Denied Pending Average Days to Initial Decision 1 UNILATERAL PRIMARY OSTEOARTHRITIS LEFT KNEE 7 2 UNILATERAL PRIMARY OSTEOARTHRITIS RIGHT KNEE 5 3 Muscle wasting and atrophy, not elsewhere classified, back, lumbosacral 4 4 DYSPHAGIA OROPHARYNGEAL PHASE 4 5 DEVIATED NASAL SEPTUM 3 6 Unilateral primary osteoarthritis, left knee 3 7 Urticaria, unspecified 3 8 Autistic disorder 2 9 DILATED CARDIOMYOPATHY 2 10 Old myocardial infarction 2 Top 10 Indications by Count of Prior Authorization Requests/Approvals/Denials:

• A medical indication is a condition, sign, or symptom indicating the need for care.

Carelon Global Solutions - Philippines Rank by Count Reason for Denial Denials Appeals Appeals Approved Appeals Denied Appeals Pending Average Days for a
Decision upon Appeal 1 Not Medically Necessary 88 2 Investigational and Not Medically Necessary 27 3 Non Covered Service 15 4 No Network Provider Available 9 5 Insufficient Information Received 5 6 Re-Review Upheld 4 7 Experimental/Investigational 2 8 Benefit Exhaust 1 9 Investigational 1 10 11 12 13 14 15 16 17 18 19 20 Top 20 Reasons for Denial by Count of Prior Authorizations Denied:

CarelonRx 2025 Indiana Utilization Report

CarelonRx Total Initial Prior Authorization Requests 19,272

Total Approved 15,861

Total Denied 3,411

Total Pending NA Denial Rate (%) 18% Average Time between Submission and Decision 0.6 days Appeals NA Appeals Approved NA Appeals Denied NA Appeals Pending NA Appeal Denial Rate (%) NA Average Time between Submission and Decision for Appeals NA Overall Prior Authorization Statistics

CarelonRx Most Requested Rank by Count Taxonomy Code Healthcare Provider Specialty Requests Approved Denied Pending Average Days to Initial Decision 1 207Q00000X Allopathic & Osteopathic Physicians - Family Medicine 3874 3068 806 0.8 2 363LF0000X Physician Assistants & Advanced Practice Nursing Providers - Nurse Practitioner - Family 3474 2788 686 0.7 3 363L00000X Physician Assistants & Advanced Practice Nursing Providers - Nurse Practitioner 1462 1208 254 0.7 4 207R00000X Allopathic & Osteopathic Physicians - Internal Medicine 1212 967 245 0.8 5 363A00000X Physician Assistants & Advanced Practice Nursing Providers - Physician Assistant 855 691 164 0.6 6 207RE0101X Allopathic & Osteopathic Physicians - Internal Medicine - Endocrinology, Diabetes & Metabolism 712 621 91 0.6 7 2084N0400X Allopathic & Osteopathic Physicians - Psychiatry & Neurology - Neurology 688 577 111 0.7 8 363LP0808X Physician Assistants & Advanced Practice Nursing Providers - Nurse Practitioner - Psychiatric/Mental Health 655 608 47 0.3 9 207N00000X Allopathic & Osteopathic Physicians - Dermatology 604 502 102 0.5 10 152W00000X Eye and Vision Services Providers - Optometrist 412 353 59 0.4 Most Approved Rank by Count Taxonomy Code Healthcare Provider Specialty Requests Approved Denied Pending Average Days to Initial Decision 1 207Q00000X Allopathic & Osteopathic Physicians - Family Medicine 3068 0.8 2 363LF0000X Physician Assistants & Advanced Practice Nursing Providers - Nurse Practitioner - Family 2788 0.7 3 363L00000X Physician Assistants & Advanced Practice Nursing Providers - Nurse Practitioner 1208 0.7 4 207R00000X Allopathic & Osteopathic Physicians - Internal Medicine 967 0.8 5 363A00000X Physician Assistants & Advanced Practice Nursing Providers - Physician Assistant 691 0.6 6 207RE0101X Allopathic & Osteopathic Physicians - Internal Medicine - Endocrinology, Diabetes & Metabolism 621 0.5 7 363LP0808X Physician Assistants & Advanced Practice Nursing Providers - Nurse Practitioner - Psychiatric/Mental Health 608 0.3 8 2084N0400X Allopathic & Osteopathic Physicians - Psychiatry & Neurology - Neurology 577 0.6 9 207N00000X Allopathic & Osteopathic Physicians - Dermatology 502 0.4 10 152W00000X Eye and Vision Services Providers - Optometrist 353 0.4 Most Denied Rank by Count Taxonomy Code Healthcare Provider Specialty Requests Approved Denied Pending Average Days to Initial Decision 1 207Q00000X Allopathic & Osteopathic Physicians - Family Medicine 806 0.7 2 363LF0000X Physician Assistants & Advanced Practice Nursing Providers - Nurse Practitioner - Family 686 0.6 3 363L00000X Physician Assistants & Advanced Practice Nursing Providers - Nurse Practitioner 254 0.7 4 207R00000X Allopathic & Osteopathic Physicians - Internal Medicine 245 0.7 5 363A00000X Physician Assistants & Advanced Practice Nursing Providers - Physician Assistant 164 0.7 6 2084N0400X Allopathic & Osteopathic Physicians - Psychiatry & Neurology - Neurology 111 1.0 7 207N00000X Allopathic & Osteopathic Physicians - Dermatology 102 1.0 8 207RE0101X Allopathic & Osteopathic Physicians - Internal Medicine - Endocrinology, Diabetes & Metabolism 91 1.0 9 207RR0500X Allopathic & Osteopathic Physicians - Internal Medicine - Rheumatology 70 1.0 10 207RG0100X Allopathic & Osteopathic Physicians - Internal Medicine - Gastroenterology 66 0.9 Top 10 Taxonomies Ranked by Count of Prior Authorization Requests/Approvals/Denials:

CarelonRx Most Requested Rank by Count Medication RxCUI (RxNorm) (IN or MIN concept) Requests Approved Denied Pending Average Days to Initial Decision 1 00169418113 RxCUI 801 663 138 0.6 2 00169452514 RxCUI 712 16 696 0.9 3 00002150680 RxCUI 623 454 169 1.0 4 08627007701 - 546 474 72 0.7 5 72618300002 RxCUI 396 311 85 1.2 6 00597015230 RxCUI 199 193 6 0.2 7 00310908012 RxCUI 192 140 52 0.7 8 00002149580 RxCUI 179 128 51 0.9 9 00169413013 RxCUI 177 154 23 0.5 10 00023650110 RxCUI 176 123 53 1.0 Most Approved Rank by Count Medication RxCUI (RxNorm) (IN or MIN concept) Requests Approved Denied Pending Average Days to Initial Decision 1 00169418113 RxCUI 663 0.7 2 08627007701 - 474 0.6 3 00002150680 RxCUI 454 1.3 4 72618300002 RxCUI 311 1.3 5 00597015230 RxCUI 193 0.2 6 00597015330 RxCUI 165 0.2 7 00143965901 RxCUI 154 0.7 8 00169413013 RxCUI 154 0.6 9 61874011530 RxCUI 152 0.2 10 59338077501 - 151 0.4 Most Denied Rank by Count Medication RxCUI (RxNorm) (IN or MIN concept) Requests Approved Denied Pending Average Days to Initial Decision 1 00169452514 RxCUI 696 0.9 2 00002150680 RxCUI 169 0.4 3 00169418113 RxCUI 138 0.3 4 72618300002 RxCUI 85 0.7 5 08627007701 - 72 0.9 6 00169450514 RxCUI 69 0.9 7 00023650110 RxCUI 53 0.5 8 00310908012 RxCUI 52 0.8 9 00002149580 RxCUI 51 0.4 10 00169452414 RxCUI 40 1.9 Top 10 Medications by Count of Prior Authorization Requests/Approvals/Denials:

CarelonRx Most Requested Rank by Count Diagnostic Test or Procedure Procedure Code Code Type (CPT, DRG,…) Requests Approved Denied Pending Average Days to Initial Decision 1 2 3 4 5 6 7 8 9 10 Most Approved Rank by Count Diagnostic Test or Procedure Procedure Code Code Type (CPT, DRG,…) Requests Approved Denied Pending Average Days to Initial Decision 1 2 3 4 5 6 7 8 9 10 Most Denied Rank by Count Diagnostic Test or Procedure Procedure Code Code Type (CPT, DRG,…) Requests Approved Denied Pending Average Days to Initial Decision 1 2 3 4 5 6 7 8 9 10 Top 10 Diagnostic Tests by Count of Prior Authorization Requests/Approvals/Denials:

CarelonRx Most Requested Rank by Count Medical Indication Requests Approved Denied Pending Average Days to Initial Decision 1 Endocrine, nutritional and metabolic diseases(E00-E89) 6146 4862 1284 0.7 2 Mental, Behavioral and Nurodevelopmental disorders(F01-F99) 2386 2245 141 0.3 3 Diseases of the nervous system(G00-G99) 1884 1504 380 0.8 4 Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified 1730 1454 276 0.7 5 Diseases of the skin and subcutaneous tissue(L00-L99) 1486 1228 258 0.5 6 Diseases of the musculoskeletal system and connective tissue(M00-M99) 923 776 147 0.7 7 Diseases of the digestive system(K00-K95) 714 575 139 0.6 8 Diseases of the genitourinary system(N00-N99) 621 520 101 1.1 9 Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism(D50-D89) 612 523 89 0.4 10 Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified(R00- R99) 547 416 131 1.2 Most Approved Rank by Count Medical Indication Requests Approved Denied Pending Average Days to Initial Decision 1 Endocrine, nutritional and metabolic diseases(E00-E89) 4862 0.7 2 Mental, Behavioral and Nurodevelopmental disorders(F01-F99) 2245 0.3 3 Diseases of the nervous system(G00-G99) 1504 0.8 4 Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified 1454 0.6 5 Diseases of the skin and subcutaneous tissue(L00-L99) 1228 0.5 6 Diseases of the musculoskeletal system and connective tissue(M00-M99) 776 0.6 7 Diseases of the digestive system(K00-K95) 575 0.5 8 Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism(D50-D89) 523 0.4 9 Diseases of the genitourinary system(N00-N99) 520 1.2 10 Diseases of the circulatory system(I00-I99) 419 0.4 Top 10 Indications by Count of Prior Authorization Requests/Approvals/Denials:

CarelonRx Most Denied Rank by Count Medical Indication Requests Approved Denied Pending Average Days to Initial Decision 1 Endocrine, nutritional and metabolic diseases(E00-E89) 1284 0.7 2 Diseases of the nervous system(G00-G99) 380 0.8 3 Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified 276 0.9 4 Diseases of the skin and subcutaneous tissue(L00-L99) 258 0.8 5 Factors influencing health status and contact with health services(Z00-Z99) 194 0.8 6 Diseases of the musculoskeletal system and connective tissue(M00-M99) 147 0.9 7 Mental, Behavioral and Nurodevelopmental disorders(F01-F99) 141 0.7 8 Diseases of the digestive system(K00-K95) 139 0.8 9 Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified(R00- R99) 131 0.8 10 Diseases of the genitourinary system(N00-N99) 101 0.8

CarelonRx Rank by Count Reason for Denial Denials Appeals Appeals Approved Appeals Denied Appeals Pending Average Days for a
Decision upon Appeal 1 Medical Necessity 3399 NA NA NA NA NA 2 Other 12 NA NA NA NA NA 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Top 20 Reasons for Denial by Count of Prior Authorizations Denied: