Payer Prior Authorization Report Check
Checks a payer's posted CMS-0057-F prior authorization report.
Open the tool → Runs in your browser. Data leaves only if you deliberately send a problem report from the interactive tool.
Example
- Kind of plan
- Medicare Advantage
- Calendar year the report covers
- 2025 year
- Posts the list of items and services needing prior authorization
- Yes
- Standard requests approved
- 92.4 percent
- Standard requests denied
- 7.6 percent
- Standard requests approved after appeal
- 81 percent
- Extended-review requests approved
- 64 percent
- Expedited requests approved
- 95 percent
- Expedited requests denied
- 5 percent
- Unit of the decision times
- Hours
The other 7 values
- Standard decisions: average time
- 98
- Standard decisions: median time
- 72
- Expedited decisions: average time
- 30
- Expedited decisions: median time
- 20
- Standard requests in all
- 1000
- Standard requests approved (count)
- 904
- Standard requests denied (count)
- 76
Result: Medicare Advantage report for 2025 (42 CFR 422.122(c), posted at the contract level by March 31, 2026): 9 of 9 required elements entered, 2 stated rates checked against counts. 1 problem found.
The tool opens with these values already filled in. Replace them with your own.
What you enter
- Kind of plan
- Calendar year the report covers
- Posts the list of items and services needing prior authorization
- Standard requests approved
- Standard requests denied
- Standard requests approved after appeal
- Extended-review requests approved
- Expedited requests approved
- Expedited requests denied
- Unit of the decision times
The other 10 fields
- Standard decisions: average time
- Standard decisions: median time
- Expedited decisions: average time
- Expedited decisions: median time
- Standard requests in all
- Standard requests approved (count)
- Standard requests denied (count)
- Expedited requests in all
- Expedited requests approved (count)
- Expedited requests denied (count)
How this is calculated
Citation
CMS Interoperability and Prior Authorization final rule (CMS-0057-F): the nine public prior authorization metrics of 42 CFR 422.122(c), 438.210(f), 440.230(e)(3), 457.732(c) and 45 CFR 156.223(c); decision deadlines of 42 CFR 422.568(b)(1), 422.572(a)(1), 438.210(d), 440.230(e)(1) and 457.495. Read the source ↗
Source: Payers' posted CMS-0057-F reports, curated (2025 subset)
A reference and educational tool. Not medical, legal, or financial advice, and not a substitute for clinician judgment.