Prior Authorization Metrics Reporting
To comply with the Centers for Medicare & Medicaid Services (CMS) Interoperability and Prior Authorization final rule, starting in 2026 impacted payers — Medicare Advantage (MA) organizations, state Medicaid and Children’s Health Insurance Program (CHIP) fee-for-service (FFS) programs, Medicaid managed care plans, CHIP managed care entities, and Qualified Health Plan (QHP) issuers on the Federally Facilitated Exchanges (FFEs) — must publicly report certain prior authorization metrics from the previous calendar year on their websites.