| The percentage of STANDARD prior authorization requests that were approved, aggregated for all items and services. |
92% |
| The percentage of STANDARD prior authorization requests that were denied, aggregated for all items and services. |
8% |
| The percentage of STANDARD prior authorization requests that were approved after an appeal, aggregated for all items and services. |
43% |
| The percentage of EXPEDITED prior authorization requests that were approved after an appeal, aggregated for all items and services. |
21% |
| The percentage of STANDARD prior authorization requests for which the review timeframe was extended, and the request was approved, aggregated for all items and services. |
NA |
| The percentage of EXPEDITED prior authorization requests for which the review timeframe was extended, and the request was approved, aggregated for all items and services. |
NA |
| The percentage of EXPEDITED prior authorization requests that were approved, aggregated for all items and services. |
90% |
| The percentage of EXPEDITED prior authorization requests that were denied, aggregated for all items and services. |
10% |
|
Timing |
| Average time that elapsed between the submission of a request and a determination by the payor, plan or issuer, for STANDARD prior authorizations, aggregated for all items and services. (Measured in days) |
4 |
| Median time that elapsed between the submission of a request and a determination by the payor, plan, issuer, for STANDARD prior authorizations, aggregated for all items and services. (Measured in days) |
3 |
| Average time that elapsed between the submission of a request and a decision by the payor, plan or issuer, for EXPEDITED prior authorizations, aggregated for all items and services. (Measured in hours) |
25 |
| Median time that elapsed between the submission of a request and a decision by the payor, plan, issuer, for EXPEDITED prior authorizations, aggregated for all items and services. (Measured in hours) |
24 |
2025 Prior Authorization Guide