MRE PRACTICAL GUIDE · TURNAROUND PERFORMANCE
Measure the Time Your Medical Review Process Actually Takes
A fast turnaround figure is useful only when your team understands what it measures. Compare the start point, stop point, pauses, case types, and reporting period before using a number to evaluate a partner or manage an internal queue.
Review speed alongside clinical quality, documentation, and operational reliability. A short reported interval does not describe every part of the process.
Define the clock
| Definition | Questions to resolve |
|---|---|
| Start | Initial receipt, complete file, acceptance, or reviewer assignment? |
| Stop | Clinical completion, quality check, delivery, or another event? |
| Pauses | Are record requests or clarification periods excluded? How are they reported? |
| Calendar | Are hours continuous, business hours, or defined coverage hours? |
| Urgency | How are standard and expedited cases classified and routed? |
| Exceptions | Which cases are excluded, and who approves the exclusion? |
Keep regulatory and operational clocks distinct
Regulatory timing requirements depend on the program and request type. CMS’s prior-authorization FAQ identifies the payers subject to its decision-timeframe requirements and explains exclusions for certain requests and plans. Confirm the rule that applies to your work before comparing a vendor’s narrower review interval with a payer’s decision deadline.
Look beyond the average
An average can hide a small group of cases that take much longer. Examine the proportion completed within the defined requirement, the distribution of elapsed times, and cases that approach or exceed the applicable deadline. Keep reporting segments consistent.
- Separate standard and expedited work.
- Compare relevant review types, specialties, and complexity groups.
- Report intake-to-delivery time as well as narrower review intervals where useful.
- Identify the number and reason for pauses and exclusions.
- Track unresolved cases, not only completed work.
A worked example: two different clocks
Fictional example: A case arrives Monday at 9 a.m. Required records are complete Tuesday at 9 a.m. The final report is delivered Wednesday at 9 a.m. Intake-to-delivery time is 48 hours; complete-file-to-delivery time is 24 hours. Both numbers describe the same case, but different portions of the process.
If a vendor reports the narrower interval and your team expects the full interval, the comparison will be misleading. Agree on definitions before setting or assessing targets. This example does not establish a deadline for any real review.
Find the source of delay
| Process stage | What to investigate |
|---|---|
| Intake | Missing information, unclear scope, or delayed completeness checks. |
| Assignment | Specialty availability, routing rules, or acceptance delays. |
| Clinical review | Questions about records, criteria, instructions, or scope. |
| Quality and delivery | Clarification, correction, formatting, or system handoff delays. |
Define an escalation process
Identify the person responsible for monitoring time at each stage, the threshold for escalation, the contact who can resolve the issue, and the communication your team expects. Document exceptions so they can be reviewed rather than disappearing from the performance report.
Questions for a review partner
- Can you provide the written definitions behind your performance reports?
- What proportion of cases is excluded, paused, or reclassified?
- How do you report cases still in progress?
- When will our team be notified that a case is at risk?
- How do you investigate recurring delays without compromising report quality?
Continue your evaluation
Assess reviewer capacity · Build a UM partner scorecard
Discuss review operations with BHM
Confirm the applicable timing requirements for each program, jurisdiction, and review type with your compliance team. This resource does not prescribe regulatory deadlines.