Payers are now required to publicly post certain prior authorization metrics, but an initial look at the first set of data offers “little insight into what gets approved or denied, according to an April 2 analysis from KFF.
Five things to know:
1. CMS finalized a 2024 rule requiring payers to publicly report prior authorization metrics, including denial rates, processing times and appeal overturn rates. The first reports, covering 2025, were due March 31.
2. The data can be difficult to locate and varies in presentation across payer websites, KFF said. Some aggregate reporting within a line of business, while others require users to navigate multiple pages.
3. The data is aggregated across all items and services, with no breakdown by service type, limiting insight into what is being approved or denied.
4. Payers are not required to report reasons for denials, and there is no way to assess whether decisions align with coverage policies.
5. Some states, such as Massachusetts and Washington, provide greater detail on payers’ practices, including metrics by service category and inclusion of prescription drugs. These states could serve as models for more useful data collection, KFF said.
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