How the Index reviews prior authorization reporting
The Prior Auth Index compiles and reviews publicly available payer prior authorization reporting, including reported metrics, source availability, publication status, and disclosure usability. This methodology describes the review process and limitations of the public reporting dataset.
What the Index tracks
The Index reviews public prior authorization reporting associated with covered health plans and payer entities. The review examines reported approval, denial, appeal, and decision-time metrics, alongside source availability, reporting format, and disclosure quality. Where available, source links are retained so readers can examine the underlying reporting and its limitations.
The dataset is a source-linked reference for public payer reporting. It does not establish the quality of individual authorization decisions, determine coverage or medical necessity, or measure the full administrative workload associated with obtaining and resolving authorizations.
Publication status
A plan or payer is treated as published when a public source appears to provide prior authorization transparency reporting associated with that entity or reporting group. Publication status reflects source availability at the time of review.
A plan or payer may be marked not published when no public source is identified, when a listed source is unavailable, or when the available page does not appear to contain the relevant prior authorization transparency reporting.
Machine-readable availability
Machine-readable availability refers to whether the reporting is provided in a format that can reasonably be parsed, extracted, or analyzed without manual reconstruction. Structured files, accessible tables, and clearly formatted datasets are generally more usable than scanned PDFs, image-based documents, broken files, or pages that require extensive manual interpretation.
Machine-readable status is separate from publication status. A payer can publish prior authorization reporting while still providing the information in a format that is difficult to compare, extract, or reuse.
Source review
Source URLs are reviewed for public accessibility, relevance to prior authorization transparency reporting, and connection to the payer or plan being tracked. Some sources may cover multiple related plans, contracts, subsidiaries, or reporting entities.
When multiple plans reference the same underlying disclosure, the Index may preserve plan-level entries while also noting that a single source can represent more than one reporting entity.
Reporting usability
Publication alone does not establish usability. The Index distinguishes between whether reporting exists and whether it is complete, accessible, source-linked, machine-readable, and meaningful for comparison across plans.
Usability issues may include missing metrics, inconsistent definitions, inaccessible files, nonstandard formats, duplicate reporting structures, or disclosures that are difficult to compare across payer entities.
Limitations
The Index relies on publicly available payer reporting and does not independently verify underlying payer calculations or internal operational records. Available disclosures may exclude unpublished information, subsequent corrections, or changes made after the latest source review.
Reported metrics should be interpreted within their source, reporting period, plan type, and stated definitions. The Index is an independent research reference, not a determination of regulatory compliance, medical necessity, or coverage.
Updates and corrections
The Index is updated as new public reporting sources are identified, reviewed, or corrected. Publication status, machine-readable status, and source URLs may change as payer reporting pages are updated.
Source corrections, missing disclosures, and reporting updates can be sent through the contact page.
Found a missing source or reporting update?
Send source corrections, missing disclosures, or public reporting updates for review.
Contact the Index