Prior Authorization Metrics

Get the analysis behind the data.

The Prior Auth Report is a monthly research brief on what's changing in prior authorization, and what it means operationally for leaders and the teams doing the work.

Source: KFF analysis of CMS Medicare Advantage data, January 2026

Data Interpretation

Published denial and approval rates are not direct quality rankings. Reporting methodologies, contract structures, aggregation standards, and partial-denial definitions vary between reporting entities and markets. The Index preserves source context while improving accessibility and comparability across publicly reported datasets. Read the Index methodology.

Reporting Coverage Notice

The comparative metrics shown here are limited to publicly available structured datasets and payer disclosures that can be reasonably normalized for comparison. Many entities tracked in the payer directory have not yet published complete or standardized prior authorization metrics.

Additional payer metrics and comparative reporting will be added as more disclosures become publicly available under CMS prior authorization transparency requirements.

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Published prior authorization denial rates for major Medicare Advantage and ACA Marketplace insurers. Plans are displayed from highest reported denial rate to lowest.

Focused research

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