Prior Authorization Metrics

To comply with the CMS Interoperability and Prior Authorization Final Rule, Martin’s Point is required to annually report aggregated prior authorization metrics on our website. Specifically, this includes a list of all medical items and services (excluding drugs) that require prior authorization, as well as data on prior authorization requests for those items and services (for example, approvals and denials) over the previous calendar year.

Publicly reporting these metrics promotes transparency and accountability, helps patients understand prior authorization processes, and enables providers to evaluate payer performance. In addition, these metrics may be used to compare plans, programs, and payers.

Prior Authorization Decision Timeframes

Prior to January 1, 2026, Medicare Advantage plans and applicable integrated plans are required to issue prior authorization decisions within the following timeframes:

• 72 hours for expedited (urgent) requests
• 14 calendar days for standard (non-urgent) requests

Beginning January 1, 2026, the CMS Interoperability and Prior Authorization Final Rule requires Medicare Advantage plans to issue prior authorization decisions within:

• 72 hours for expedited (urgent) requests
• 7 calendar days for standard (non-urgent) requests

Reporting Period: 2025

Medical Items and Services Requiring Prior Authorization (Excluding Drugs) – 2025 [PDF]

Prior Authorization Requests and Decision Timelines – 2025 [PDF]