Prior authorization data is now public — but it is not giving much to work with.
CMS’ Interoperability and Prior Authorization Final Rule from 2024 focused on easing prior authorization across government-affiliated healthcare programs. Involved payers now have to report certain aggregated metrics, such as approval and denial rates.
Data covering 2025 went live March 31, 2026. At the time, KFF said insights were limited. The organization has since revisited the data, extracting findings where it could and flagging room for improvement.
Here are eight things to know from KFF’s Aug. 13 analysis:
- Medicare Advantage, Medicaid managed care and ACA marketplace insurers denied 12%, 14% and 18% of prior authorization requests, respectively. Rates for expedited requests were a bit lower. The aggregated approval data prevents deeper analysis of which services were rejected, KFF said.
- While prior authorization denial appeals are rare, 67%, 47% and 43% of appealed decisions were overturned for MA, Medicaid managed care and ACA, respectively.
- There was a stark contrast with overturned requests in the MA market. Looking at insurers with the largest enrollment, Centene overturned the greatest share, 93%, of its appeals. Kaiser Permanente overturned 40%.
- Median response times across markets were roughly one day for standard prior authorization requests. Between product types, there was more variation for expedited requests, ranging from half of one day for MA to one day for the ACA marketplace. Insurers did not need to share response time ranges by service category.
- Out of six reviewed MA insurers, standard prior authorization denial rates ranged from 5% for Elevance Health to 17% for UnitedHealth Group.
- Among eight Medicaid managed care insurers, standard prior authorization denial rates spanned from 2% for L.A. Care Health Plan to 23% for Independence Health Group.
- Of the eight reviewed marketplace insurers, standard prior authorization denial rates ranged from 3% for GuideWell to 25% for Centene.
- Some other remaining challenges: Insurers do not have to report the number of prior authorization requests for each metric, there could be inconsistencies in how metrics are logged, and insurers only need to report median and average response times.
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