Payer prior authorization metrics have long been a 'black box' for providers. But on March 31, 2026, a new federal rule forced certain insurers (i.e., Medicare Advantage plans, state Medicaid and Children's Health Insurance Program fee-for-service programs, Medicaid managed care plans, and plans on the Affordable Care Act exchanges) to publicly report approval rates, denial rates, and decision turnaround times to help curb administrative burden.

For providers, the rule — which is part of a larger federal effort to cut red tape, creating concrete opportunities to optimize revenue cycle workflows. 

TL;DR

On March 31, 2026, a new federal rule forced major health insurers to publicly report their prior authorization approval rates, denial rates, and turnaround times. While this data lack clinical context and varies by plan standards, healthcare practices can use these public benchmarks as an early warning system to:

As payers begin to publicly report these metrics, providers will have a unique glimpse into patterns in payer behavior as well as outlier trends, potential contracting opportunities, and more. Public prior authorization denial data is highly valuable because it addresses several key challenges on the provider side.

Payers use different prior authorization requirements, medical necessity criteria, coverage policies, documentation expectations, and claims editing rules, making it difficult for providers to stay on top of evolving rules. Being able to access public prior authorization denial data helps providers remain compliant across diverse payers more easily.

In addition to increased complexity of prior authorization rules and requirements, prior authorizations are also increasing in terms of volume—particularly among Medicare Advantage plans. Nearly 53 million prior authorization requests were submitted to Medicare Advantage insurers on behalf of Medicare Advantage enrollees in 2024. Medicare Advantage insurers fully or partially denied 4.1 million of these requests, and although a small share of denied prior authorization requests were appealed to Medicare Advantage insurers, most appeals (80.7%) were partially or fully overturned. 

Even the Office of Inspector General called attention to the increased volume of Medicare Advantage prior authorization denials in this report that also highlights concerns about beneficiary access to medically necessary items and services. Public prior authorization denial data helps streamline workflows for increasingly vulnerable patients.

As prior authorization complexity and volume continue to skyrocket, there’s a negative impact on patient care. Ninety-five percent of physicians report care delays and 26% of physicians say a prior authorization led to a serious adverse event for a patient in their care. 

Public prior authorization data acts as an early warning system exposing emerging payer behavior shifts before they impact your practice’s bottom line. Fortunately, there are several ways practices can use the data proactively. Managing medical billing denials doesn't have to overwhelm your staff if you use this information to predict workflow strain.

Leverage these newly disclosed metrics to compare prior authorization metrics such as denial rates, approval rates, decision turnaround times, volume of requests, and appeal overturn rates across payers.

Analyze the public datasets to look for patterns and identify potential areas where staff may be spending disproportionate time on repeated submissions, additional documentation requests, manual follow-up, or appeals. 

For example, if one payer consistently reports longer approval times and higher denial rates for imaging or specialty services compared with peers, practices can flag those workflows for process redesign, create payer-specific documentation checklists, strengthen front-end authorization procedures, or dedicate staff resources to those high-burden areas.

Practices can include payer turnaround and denial trends in workforce planning and leverage it to understand where additional time and resources may be necessary. 

For example, if a payer consistently reports above-average denial rates and high appeal reversal rates, a practice can anticipate increased staff workload, allocate resources proactively, strengthen documentation processes, and prepare for potential delays in reimbursement and patient scheduling.

However, practices must keep in mind that denial rates alone only reveal part of the picture. That’s because payers overturn many of these denials upon provider appeal. This means data on the percentage of overturned denials is equally as important. 

When looking at public prior authorization denial data, it’s important to look at overturned denials because an insurer’s first decision and its final determination after additional review and documentation may differ. Fortunately, per the prior authorization rule requiring payer transparency and accountability, payers must publicly disclose the following appeal-related information:

[Note that payers must also publicly report the average time to decision, list of services (excluding prescription drugs) requiring prior authorization, specific reason for denial, and total number prior authorization requests including the percentage approved or denied].

It’s important to note that not all health plans will report the same information simultaneously, nor will each payer’s metric definitions exactly align. Consider the following:

Here are examples of prior authorization data available from three large insurers:

Another important consideration is that authorization data often lacks clinical context, because it typically captures administrative transaction details rather than the full patient story behind the request. Without this clinical context, the data may be difficult to interpret because it doesn’t reveal whether denials reflected documentation gaps, evolving coverage policies, medical necessity disagreements, or legitimate differences in patient complexity.

To respond proactively, practices should focus on three operational shifts:

Leverage denial data to strengthen documentation templates, standardize required prior authorization clinical elements, and align records more closely with payer policies.

Use the performance benchmarks to create consistent, payer-specific processes and documentation requirements such as payer-specific authorization checklists for common services, standard documentation templates that include medical necessity elements, and predefined workflows and escalation pathways for denials or exceptions.

To eliminate manual errors, practices can deploy integrated electronic health records (EHR) and medical billing software to automatically flag prior authorization rules and verify insurance eligibility before a patient arrives.

Review prior authorization data to identify patterns in denial rates, prior authorization volume, approval times, appeal outcomes, and payer-specific requirements and then adjust resources and workflows accordingly.