Prior Authorization Reporting Metrics

We are required by federal law to share this information each year on our website. Specifically, we share information about services that require prior authorization, as well as counts on prior authorization requests for those items and services (e.g., approvals, denials) from the previous calendar year.

Prior authorization means your provider must get approval from us before you receive certain medical services or items. This information does not include prescription drugs.

On this page, you will find:

• A list of medical services and items that require prior authorization list of all medical items and services (not including drugs).
• A summary of prior authorization requests from last year prior authorization metrics.

If you have questions, please contact Member Services at (877) 336-2069 (TTY: 877-206-0500). From October 1^st to March 31^st, we are open 7 days a week from 8 a.m. to 8 p.m. EST. From April 1^st to September 30^th, we are open Monday through Friday, 8 a.m. to 8 p.m. EST.

 

Scorecard for Year 2025

The percentage of prior standard authorization requests that were approved, aggregated for all items and services	97.61%
The percentage of standard prior authorization requests that were denied, aggregated for all items and services	2.39%
The percentage of standard prior authorization requests that were approved after appeal, aggregated for all items and services	56.37%
The percentage of prior authorization requests for which the timeframe for review was extended, and the request was approved, aggregated for all items and services	78.57%
The percentage of expedited prior authorization requests that were approved, aggregated for all items and services	98.78%
The percentage of expedited prior authorization requests that were denied, aggregated for all items and services	1.22%
The average time that elapsed between the submission of a request and a determination by the payer, plan, or issuer, for standard prior authorizations, aggregated for all items and services	0.4 days
The median time that elapsed between the submission of a request and a determination by the payer, plan, or issuer, for standard prior authorizations, aggregated for all items and services	0 days (same day)
The average time that elapsed between the submission of a request and a decision by the payer, plan, or issuer, for expedited prior authorizations, aggregated for all items and services	6 hours
The median time that elapsed between the submission of a request and a decision by the payer, plan, or issuer, for expedited prior authorizations, aggregated for all items and services	1 hour