To comply with the CMS Interoperability and Prior Authorization final rule, CDPHP 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 (e.g., approvals, denials, etc.) 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, metrics can be used to compare plans, programs, and payers.
Reporting Period: 1/1/2025 – 12/31/2025
Prior Authorization Metrics - Child Health Plus
Prior Authorization Metrics - Medicaid
Prior Authorization Metrics - Medicaid HARP
Prior Authorization Metrics - Medicare HMO
Prior Authorization Metrics - Medicare PPO
Prior Authorization Code List
Clinical Review Preauthorization List can be found in table of contents of Health Policies PDF