Prior Authorization Reporting Dataset
Prior Authorization Metrics
Published prior authorization denial, approval, and appeal reporting across major U.S. health plans, aggregated from CMS, KFF analysis, payer transparency disclosures, and linked reporting sources.
Primary year
CY 2024
Sources
CMS / KFF
Rule context
CMS-0057-F
Coverage
MA
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The Prior Auth Report is a monthly research brief on what's changing in prior authorization, and what it means operationally for leaders and the teams doing the work.
Get Index updatesMedicare Advantage Snapshot — Calendar Year 2024
52.8M
Prior authorization determinations issued
4.1M
Requests denied fully or partially
80.7%
Appealed denials overturned
11.5%
Denied requests ever appealed
Data Interpretation
Published denial and approval rates are not direct quality rankings. Reporting methodologies, contract structures, aggregation standards, and partial-denial definitions vary between reporting entities and markets. The Index preserves source context while improving accessibility and comparability across publicly reported datasets. Read the Index methodology.
Reporting Coverage Notice
The comparative metrics shown here are limited to publicly available structured datasets and payer disclosures that can be reasonably normalized for comparison. Many entities tracked in the payer directory have not yet published complete or standardized prior authorization metrics.
Additional payer metrics and comparative reporting will be added as more disclosures become publicly available under CMS prior authorization transparency requirements.
Additional payer metrics and comparative reporting will be added as more disclosures become publicly available under CMS prior authorization transparency requirements.
Public payer reporting under CMS-0057-F began appearing broadly in 2026. Reporting quality and disclosure consistency still vary significantly across payers and reporting entities.
Aetna (CVS Health)Company-reported data
Approval Rate
95%
Denial Rate
5%
Avg Decision Time
Under 24 hours
Company-reported CVS Health/Aetna statement: more than 95% of eligible prior authorizations approved within 24 hours, with 77% of electronic PAs approved in real time. This is not presented as a standardized CMS disclosure table.
CVS Health Press Release, Jan 2026Alabama Medicaid (Expedited Requests)CMS disclosure
Approval Rate
81%
Denial Rate
19%
Avg Decision Time
Same day
2025 prior authorization metrics. Expedited prior authorizations approved: 81%. Denied: 19%. Decision time reported as same day.
Alabama Medicaid Prior Authorization Metrics 2025 (PDF)Alabama Medicaid (Standard Requests)CMS disclosure
Approval Rate
90%
Denial Rate
10%
Avg Decision Time
2 days
2025 prior authorization metrics. Standard prior authorizations approved: 90%. Denied: 10%. Appeals data was suppressed or unavailable due to low volume.
Alabama Medicaid Prior Authorization Metrics 2025 (PDF)Braven Health (Medicare Advantage - Expedited Requests)Plan-reported data
Approval Rate
99.8%
Denial Rate
0.2%
Avg Decision Time
1 day
2025 prior authorization metrics. Expedited prior authorizations approved: 99.8%. Denied: 0.2%. Appeals approved: 96.2%.
Horizon Blue Cross Blue Shield NJ Prior Authorization ReportsBraven Health (Medicare Advantage - Standard Requests)Plan-reported data
Approval Rate
99.5%
Denial Rate
0.5%
Avg Decision Time
3 days
2025 prior authorization metrics. Standard prior authorizations approved: 99.5%. Denied: 0.5%. Appeals approved: 96.2%.
Horizon Blue Cross Blue Shield NJ Prior Authorization ReportsCigna (Expedited Requests)CMS disclosure
Approval Rate
78%
Denial Rate
22%
Avg Decision Time
1.53 days
Expedited (urgent) requests for ACA Marketplace / Individual plans on the federal exchange.
Cigna CMS Prior Authorization Disclosure Report (PDF)Cigna (Standard Requests)CMS disclosure
Approval Rate
73%
Denial Rate
27%
Avg Decision Time
3.95 days
ACA Marketplace / Individual plans on the federal exchange. Appeal overturn rate: 16%.
Cigna CMS Prior Authorization Disclosure Report (PDF)Healthfirst (Child Health Plus - Expedited Requests)CMS disclosure
Approval Rate
59%
Denial Rate
41%
Avg Decision Time
9.77 hrs
2025 prior authorization metrics. Expedited prior authorizations approved: 59% (302 of 513). Denied: 41%.
Healthfirst CMS Interoperability ReportingHealthfirst (Child Health Plus - Standard Requests)CMS disclosure
Approval Rate
72%
Denial Rate
28%
Avg Decision Time
2.11 days
2025 prior authorization metrics. Standard prior authorizations approved: 72% (20,433 of 28,487). Denied: 28%. Appeals approved: 3% (27 of 869).
Healthfirst CMS Interoperability ReportingApproval Rate
65%
Denial Rate
35%
Avg Decision Time
6.36 hrs
2025 prior authorization metrics. Expedited prior authorizations approved: 65% (356 of 546). Denied: 35%.
Healthfirst CMS Interoperability ReportingApproval Rate
85%
Denial Rate
15%
Avg Decision Time
1.55 days
2025 prior authorization metrics. Standard prior authorizations approved: 85% (46,120 of 54,478). Denied: 15%. Appeals approved: 21% (202 of 958).
Healthfirst CMS Interoperability ReportingApproval Rate
97%
Denial Rate
3%
Avg Decision Time
20.1 hrs
2025 prior authorization metrics. Expedited prior authorizations approved: 97% (134 of 138). Denied: 3%.
Healthfirst CMS Interoperability ReportingApproval Rate
97%
Denial Rate
3%
Avg Decision Time
2.03 days
2025 prior authorization metrics. Standard prior authorizations approved: 97% (68,477 of 70,748). Denied: 3%. No standard appeals were filed in 2025.
Healthfirst CMS Interoperability ReportingHealthfirst (Medicaid Managed Care - Expedited Requests)CMS disclosure
Approval Rate
60%
Denial Rate
40%
Avg Decision Time
9.18 hrs
2025 prior authorization metrics. Expedited prior authorizations approved: 60% (6,231 of 10,464). Denied: 40%.
Healthfirst CMS Interoperability ReportingHealthfirst (Medicaid Managed Care - Standard Requests)CMS disclosure
Approval Rate
80%
Denial Rate
20%
Avg Decision Time
1.62 days
2025 prior authorization metrics. Standard prior authorizations approved: 80% (603,021 of 750,763). Denied: 20%. Appeals approved: 14% (1,725 of 12,073).
Healthfirst CMS Interoperability ReportingApproval Rate
82%
Denial Rate
18%
Avg Decision Time
9 hrs
2025 prior authorization metrics. Expedited prior authorizations approved: 82% (58 of 71). Denied: 18%.
Healthfirst CMS Interoperability ReportingApproval Rate
90%
Denial Rate
10%
Avg Decision Time
1.69 days
2025 prior authorization metrics. Standard prior authorizations approved: 90% (2,998 of 3,316). Denied: 10%. Appeals approved: 96% (47 of 49).
Healthfirst CMS Interoperability ReportingApproval Rate
85%
Denial Rate
15%
Avg Decision Time
8 hrs
2025 prior authorization metrics. Expedited prior authorizations approved: 85% (5,911 of 6,956). Denied: 15%.
Healthfirst CMS Interoperability ReportingApproval Rate
92%
Denial Rate
8%
Avg Decision Time
1.54 days
2025 prior authorization metrics. Standard prior authorizations approved: 92% (701,699 of 764,446). Denied: 8%. Appeals approved: 86% (6,263 of 7,292).
Healthfirst CMS Interoperability ReportingApproval Rate
83%
Denial Rate
17%
Avg Decision Time
7 hrs
2025 prior authorization metrics. Expedited prior authorizations approved: 83% (559 of 674). Denied: 17%.
Healthfirst CMS Interoperability ReportingApproval Rate
90%
Denial Rate
10%
Avg Decision Time
1.44 days
2025 prior authorization metrics. Standard prior authorizations approved: 90% (47,266 of 52,494). Denied: 10%. Appeals approved: 90% (458 of 507).
Healthfirst CMS Interoperability ReportingApproval Rate
85%
Denial Rate
15%
Avg Decision Time
7 hrs
2025 prior authorization metrics. Expedited prior authorizations approved: 85% (175 of 207). Denied: 15%.
Healthfirst CMS Interoperability ReportingApproval Rate
90%
Denial Rate
10%
Avg Decision Time
1.46 days
2025 prior authorization metrics. Standard prior authorizations approved: 90% (9,989 of 11,134). Denied: 10%. Appeals approved: 93% (154 of 166).
Healthfirst CMS Interoperability ReportingHealthfirst (MLTC - Expedited Requests)CMS disclosure
Approval Rate
76%
Denial Rate
24%
Avg Decision Time
21.2 hrs
2025 prior authorization metrics. Expedited prior authorizations approved: 76% (50 of 66). Denied: 24%.
Healthfirst CMS Interoperability ReportingHealthfirst (MLTC - Standard Requests)CMS disclosure
Approval Rate
87%
Denial Rate
13%
Avg Decision Time
2.08 days
2025 prior authorization metrics. Standard prior authorizations approved: 87% (26,471 of 30,359). Denied: 13%. Appeals approved: 10% (32 of 309).
Healthfirst CMS Interoperability ReportingHorizon NJ FamilyCare (Medicaid - Expedited Requests)Plan-reported data
Approval Rate
90.7%
Denial Rate
9.3%
Avg Decision Time
2 days
2025 prior authorization metrics. Expedited prior authorizations approved: 90.7%. Denied: 9.3%. Appeals approved: 25.3%.
Horizon Blue Cross Blue Shield NJ Prior Authorization ReportsHorizon NJ FamilyCare (Medicaid - Standard Requests)Plan-reported data
Approval Rate
82.3%
Denial Rate
17.7%
Avg Decision Time
7 days
2025 prior authorization metrics. Standard prior authorizations approved: 82.3%. Denied: 17.7%. Appeals approved: 25.3%.
Horizon Blue Cross Blue Shield NJ Prior Authorization ReportsHorizon NJ TotalCare (HMO D-SNP - Expedited Requests)Plan-reported data
Approval Rate
99.9%
Denial Rate
0.1%
Avg Decision Time
1 day
2025 prior authorization metrics. Expedited prior authorizations approved: 99.9%. Denied: 0.1%. Appeals approved: 74.4%.
Horizon Blue Cross Blue Shield NJ Prior Authorization ReportsHorizon NJ TotalCare (HMO D-SNP - Standard Requests)Plan-reported data
Approval Rate
97.3%
Denial Rate
2.7%
Avg Decision Time
6 days
2025 prior authorization metrics. Standard prior authorizations approved: 97.3%. Denied: 2.7%. Appeals approved: 74.4%.
Horizon Blue Cross Blue Shield NJ Prior Authorization ReportsApproval Rate
66.48%
Denial Rate
33.52%
Avg Decision Time
1.1 days
2025 prior authorization metrics, NAIC 29341. Expedited approved: 66.48%. Adverse determinations: 33.52%. Appeals approved: 45.65%.
Oscar Health 2025 State Prior Authorization Statistics (PDF)Approval Rate
83.38%
Denial Rate
16.62%
Avg Decision Time
1.6 days
2025 prior authorization metrics, NAIC 29341. Standard approved: 83.38%. Adverse determinations: 16.62%. Appeals approved: 50.00%.
Oscar Health 2025 State Prior Authorization Statistics (PDF)Oscar Health (All Markets - Expedited Requests)CMS disclosure
Approval Rate
82.39%
Denial Rate
17.61%
Avg Decision Time
1.4 days
2025 All Markets prior authorization utilization statistics. Expedited prior authorizations approved: 82.39%. Expedited adverse determinations (including total and partial): 17.61%. Prior authorization appeals approved: 42.69%.
Oscar Health 2025 All Markets Prior Authorization Utilization Statistics (PDF)Oscar Health (All Markets - Standard Requests)CMS disclosure
Approval Rate
81.69%
Denial Rate
18.31%
Avg Decision Time
3.7 days
2025 All Markets prior authorization utilization statistics. Standard prior authorizations approved: 81.69%. Standard adverse determinations (including total and partial): 18.31%. Prior authorization appeals approved: 42.69%.
Oscar Health 2025 All Markets Prior Authorization Utilization Statistics (PDF)Approval Rate
65.28%
Denial Rate
34.72%
Avg Decision Time
1.9 days
2025 prior authorization metrics, NAIC 69803. Expedited approved: 65.28%. Adverse determinations: 34.72%. Appeals approved: 22.22%.
Oscar Health 2025 State Prior Authorization Statistics (PDF)Approval Rate
82.93%
Denial Rate
17.07%
Avg Decision Time
2.1 days
2025 prior authorization metrics, NAIC 69803. Standard approved: 82.93%. Adverse determinations: 17.07%. Appeals approved: 43.75%.
Oscar Health 2025 State Prior Authorization Statistics (PDF)Oscar Health Plan, Inc. (Arizona - Expedited Requests)CMS disclosure
Approval Rate
75.15%
Denial Rate
24.85%
Avg Decision Time
2.0 days
2025 prior authorization metrics, NAIC 13877. Expedited approved: 75.15%. Adverse determinations: 24.85%. Appeals approved: 40.00%.
Oscar Health 2025 State Prior Authorization Statistics (PDF)Oscar Health Plan, Inc. (Arizona - Standard Requests)CMS disclosure
Approval Rate
81.11%
Denial Rate
18.89%
Avg Decision Time
4.1 days
2025 prior authorization metrics, NAIC 13877. Standard approved: 81.11%. Adverse determinations (incl. total/partial): 18.89%. Appeals approved: 44.83%.
Oscar Health 2025 State Prior Authorization Statistics (PDF)Oscar Insurance Company (Iowa - Expedited Requests)CMS disclosure
Approval Rate
57.48%
Denial Rate
42.52%
Avg Decision Time
2.0 days
2025 prior authorization metrics, NAIC 45819. Expedited approved: 57.48%. Adverse determinations: 42.52%. Appeals approved: 55.56%.
Oscar Health 2025 State Prior Authorization Statistics (PDF)Oscar Insurance Company (Iowa - Standard Requests)CMS disclosure
Approval Rate
82.38%
Denial Rate
17.62%
Avg Decision Time
3.8 days
2025 prior authorization metrics, NAIC 45819. Standard approved: 82.38%. Adverse determinations: 17.62%. Appeals approved: 33.87%.
Oscar Health 2025 State Prior Authorization Statistics (PDF)Oscar Insurance Company (Kansas - Expedited Requests)CMS disclosure
Approval Rate
72.21%
Denial Rate
27.79%
Avg Decision Time
1.0 day
2025 prior authorization metrics, NAIC 43490. Expedited approved: 72.21%. Adverse determinations: 27.79%. Appeals approved: 38.10%.
Oscar Health 2025 State Prior Authorization Statistics (PDF)Oscar Insurance Company (Kansas - Standard Requests)CMS disclosure
Approval Rate
86.04%
Denial Rate
13.96%
Avg Decision Time
4.1 days
2025 prior authorization metrics, NAIC 43490. Standard approved: 86.04%. Adverse determinations: 13.96%. Appeals approved: 48.39%.
Oscar Health 2025 State Prior Authorization Statistics (PDF)Oscar Insurance Company (Michigan - Expedited Requests)CMS disclosure
Approval Rate
75.45%
Denial Rate
24.55%
Avg Decision Time
1.0 day
2025 prior authorization metrics, NAIC 77739. Expedited approved: 75.45%. Adverse determinations: 24.55%. Appeals approved: 50.00%.
Oscar Health 2025 State Prior Authorization Statistics (PDF)Oscar Insurance Company (Michigan - Standard Requests)CMS disclosure
Approval Rate
79.55%
Denial Rate
20.45%
Avg Decision Time
4.8 days
2025 prior authorization metrics, NAIC 77739. Standard approved: 79.55%. Adverse determinations: 20.45%. Appeals approved: 73.33%.
Oscar Health 2025 State Prior Authorization Statistics (PDF)Oscar Insurance Company (Missouri - Expedited Requests)CMS disclosure
Approval Rate
66.83%
Denial Rate
33.17%
Avg Decision Time
1.0 day
2025 prior authorization metrics, NAIC 69512. Expedited approved: 66.83%. Adverse determinations: 33.17%. Appeals approved: 44.44%.
Oscar Health 2025 State Prior Authorization Statistics (PDF)Oscar Insurance Company (Missouri - Standard Requests)CMS disclosure
Approval Rate
83.9%
Denial Rate
16.1%
Avg Decision Time
2.2 days
2025 prior authorization metrics, NAIC 69512. Standard approved: 83.90%. Adverse determinations: 16.10%. Appeals approved: 50.00%.
Oscar Health 2025 State Prior Authorization Statistics (PDF)Oscar Insurance Company (Nebraska - Expedited Requests)CMS disclosure
Approval Rate
62.11%
Denial Rate
37.89%
Avg Decision Time
1.0 day
2025 prior authorization metrics, NAIC 57424. Expedited approved: 62.11%. Adverse determinations: 37.89%. Appeals approved: 100.00%.
Oscar Health 2025 State Prior Authorization Statistics (PDF)Oscar Insurance Company (Nebraska - Standard Requests)CMS disclosure
Approval Rate
83.23%
Denial Rate
16.77%
Avg Decision Time
3.6 days
2025 prior authorization metrics, NAIC 57424. Standard approved: 83.23%. Adverse determinations: 16.77%. Appeals approved: 50.00%.
Oscar Health 2025 State Prior Authorization Statistics (PDF)Oscar Insurance Company (Oklahoma - Expedited Requests)CMS disclosure
Approval Rate
75%
Denial Rate
25%
Avg Decision Time
1.8 days
2025 prior authorization metrics, NAIC 91908. Expedited approved: 75.00%. Adverse determinations: 25.00%. Appeals approved: 50.00%.
Oscar Health 2025 State Prior Authorization Statistics (PDF)Oscar Insurance Company (Oklahoma - Standard Requests)CMS disclosure
Approval Rate
81.54%
Denial Rate
18.46%
Avg Decision Time
2.9 days
2025 prior authorization metrics, NAIC 91908. Standard approved: 81.54%. Adverse determinations: 18.46%. Appeals approved: 100.00%.
Oscar Health 2025 State Prior Authorization Statistics (PDF)Oscar Insurance Company (Tennessee - Expedited Requests)CMS disclosure
Approval Rate
73.34%
Denial Rate
26.66%
Avg Decision Time
0.9 days
2025 prior authorization metrics, NAIC 23552. Expedited approved: 73.34%. Adverse determinations: 26.66%. Appeals approved: 56.36%.
Oscar Health 2025 State Prior Authorization Statistics (PDF)Oscar Insurance Company (Tennessee - Standard Requests)CMS disclosure
Approval Rate
88.11%
Denial Rate
11.89%
Avg Decision Time
2.3 days
2025 prior authorization metrics, NAIC 23552. Standard approved: 88.11%. Adverse determinations: 11.89%. Appeals approved: 47.41%.
Oscar Health 2025 State Prior Authorization Statistics (PDF)Oscar Insurance Company (Texas - Expedited Requests)CMS disclosure
Approval Rate
69.67%
Denial Rate
30.33%
Avg Decision Time
2.0 days
2025 prior authorization metrics, NAIC 20069. Expedited approved: 69.67%. Adverse determinations: 30.33%. Appeals approved: 45.93%.
Oscar Health 2025 State Prior Authorization Statistics (PDF)Oscar Insurance Company (Texas - Standard Requests)CMS disclosure
Approval Rate
77.29%
Denial Rate
22.71%
Avg Decision Time
2.0 days
2025 prior authorization metrics, NAIC 20069. Standard approved: 77.29%. Adverse determinations: 22.71%. Appeals approved: 50.55%.
Oscar Health 2025 State Prior Authorization Statistics (PDF)Approval Rate
71.19%
Denial Rate
28.81%
Avg Decision Time
1.0 day
2025 prior authorization metrics, NAIC 45845. Expedited approved: 71.19%. Adverse determinations: 28.81%. Appeals approved: 35.71%.
Oscar Health 2025 State Prior Authorization Statistics (PDF)Approval Rate
81.6%
Denial Rate
18.4%
Avg Decision Time
2.4 days
2025 prior authorization metrics, NAIC 45845. Standard approved: 81.60%. Adverse determinations: 18.40%. Appeals approved: 63.33%.
Oscar Health 2025 State Prior Authorization Statistics (PDF)Security Health Plan (BadgerCare Medicaid - Expedited Requests)Plan-reported data
Approval Rate
92.2%
Denial Rate
7.8%
Avg Decision Time
0.6 days
2025 prior authorization metrics. Expedited prior authorizations approved: 92.2%. Denied: 7.8%. Appeals approved: 34 requests.
Security Health Plan Prior Authorization Metrics 2025 (PDF)Security Health Plan (BadgerCare Medicaid - Standard Requests)Plan-reported data
Approval Rate
87.7%
Denial Rate
12.3%
Avg Decision Time
1 day
2025 prior authorization metrics. Standard prior authorizations approved: 87.7%. Denied: 12.3%. Appeals approved: 690 requests.
Security Health Plan Prior Authorization Metrics 2025 (PDF)Sendero Health Plans (TX)No CMS-0057-F metrics found
Approval Rate
N/A
Denial Rate
N/A
Avg Decision Time
Not published
Sendero's published URL resolves to a Transparency in Coverage page containing machine-readable pricing files, including in-network rates and allowed amounts. Prior authorization metrics required under CMS-0057-F, including approval rates, denial rates, decision timeframes, and appeal outcomes, were not present at the reviewed location.
Sendero Health Plans Transparency in Coverage PageUnitedHealthcareCMS disclosure
Approval Rate
91.7%
Denial Rate
8.3%
Avg Decision Time
24 hours
98% of claims did not require prior authorization. Nearly half of all PAs approved in real time.
UnitedHealthcare CMS Compliance PageUtah Medicaid FFS (Expedited Requests)CMS disclosure
Approval Rate
98%
Denial Rate
2%
Avg Decision Time
4.48 days
2025 prior authorization metrics. Expedited prior authorizations approved: ~98% (92 of 94 requests). Denied: ~2% (2 of 94 requests). Utah Medicaid reported an average expedited decision time of 4.48 days.
Utah Medicaid Prior Authorization Annual Metrics Report 2025 (PDF)Utah Medicaid FFS (Standard Requests)CMS disclosure
Approval Rate
97%
Denial Rate
3%
Avg Decision Time
4.81 days
2025 prior authorization metrics. Standard prior authorizations approved: ~97%. Denied: ~3%. Total standard requests: 30,072. Extended requests included: 182 approved with extension (~1%), 11 denied with extension (~0%). Appeals data not separately reported.
Utah Medicaid Prior Authorization Annual Metrics Report 2025 (PDF)Wisconsin Medicaid / CHIP (Expedited Requests)CMS disclosure
Approval Rate
90%
Denial Rate
0%
Avg Decision Time
6.3 days
2025 prior authorization metrics. Expedited prior authorization requests approved: 90.0%. Denied: 0.0%. Partially denied: 10.0%. Total expedited requests: 10. Mean decision time: 6.3 days; median decision time: 2.8 days.
Wisconsin Medicaid Prior Authorization Data 2025Wisconsin Medicaid / CHIP (Standard Requests)CMS disclosure
Approval Rate
90.2%
Denial Rate
4%
Avg Decision Time
3.1 days
2025 prior authorization metrics. Standard prior authorization requests approved: 90.2%. Denied: 4.0%. Partially denied: 5.9%. Total standard requests: 165,012. Mean decision time: 3.1 days; median decision time: 1.0 day.
Wisconsin Medicaid Prior Authorization Data 2025Wyoming Medicaid CME / Magellan (Standard Requests)CMS disclosure
Approval Rate
100%
Denial Rate
0%
Avg Decision Time
8 calendar days
2025 prior authorization metrics. Standard prior authorizations approved: 100%. Denied: 0%. No expedited requests were reported. Volume not confirmed.
Wyoming Medicaid Prior Authorization Metrics 2025 (PDF)Wyoming Medicaid HCBS (Standard Requests)CMS disclosure
Approval Rate
100%
Denial Rate
0%
Avg Decision Time
<24 hours
2025 prior authorization metrics. Standard prior authorizations approved: 100%. Denied: 0%. No expedited process reported. Volume not confirmed.
Wyoming Medicaid Prior Authorization Metrics 2025 (PDF)Approval Rate
87%
Denial Rate
13%
Avg Decision Time
3 days
2025 prior authorization metrics. Standard prior authorizations approved: 87%. Denied: 13%. Appeals approved: 25%. No expedited requests reported.
Wyoming Medicaid Prior Authorization Metrics 2025 (PDF)Focused research
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