On March 31, 2026, one of the most significant components of CMS’ Interoperability and Prior Authorization final rule (CMS-0057-F) took effect: impacted payors were required to publicly report prior authorization metrics covering calendar year (CY) 2025. Required metrics include authorization volumes, approval and denial rates, appeal outcomes, and average decision turnaround times.
As a result, providers now have access to prior authorization performance data that was historically unavailable or difficult to obtain. While the first year of payor reporting under CMS-0057-F has revealed limitations, it also represents a significant step toward greater transparency in the authorization process.
Where Can Providers Access Publicly Reported Payor Prior Authorization Data?
AuthDenied has emerged as an independent project to aggregate, compile, and normalize the data to make it easier for both providers and patients to access and compare it. According to the AuthDenied database, as of July 21, 2026, 92% of payor plans required to publish CY 2025 performance metrics publicly have done so.1
What Trends Have Emerged From the Public Payor Prior Authorization Data?
Findings from the aggregated data2 have revealed several key trends:
- Many denials are not appealed, even though the success rate is high. More than half (52.6%) of appealed denials were overturned at the median plan, yet only 7.3% of denials were appealed.
- There is high variation in denial rates across plans. Median denial rates range from 7.2% in Medicare Advantage to approximately 12% to 14% in Medicaid Managed Care, Children’s Health Insurance Program (CHIP), and Marketplace plans. There is substantial variation not only across types of insurance products, but also across plans and contracts within the same insurance company.
- Denial rates do not appear to be affected by the number of services for which a plan requires authorization. AuthDenied identified a low correlation between denial rates for plans that required authorization for all 40 services that require reporting versus those that required authorization for fewer than 10 services.
There are key limitations in the reporting available today, including a lack of granular detail below the plan level, inconsistent reporting methodologies across payors, and difficulty in accessing the reporting for providers and patients. These limitations make it challenging to directly compare plans and identify the key drivers of authorization performance.
How Can Hospitals Use Publicly Reported Payor Prior Authorization Data?
Despite these limitations, hospitals and patients may be able to use the data today to help drive improvements in areas including:
- Revenue Cycle Operations: The data can help hospitals better understand their organization’s authorization performance against the payor data and drive workflow improvement discussions.
- Managed Care: Establishing meaningful, objective data points can help hospitals during payor negotiations and benchmarking.
- Plan Selection & Appeals: Understanding how payor prior authorizations are performing can inform patient insurance plan selection.
The upcoming CMS-0057-F Prior Authorization API requirements taking effect January 1, 2027 may further accelerate innovation by creating opportunities for providers, vendors, and other organizations to combine more real-time and structured authorization data with publicly reported performance metrics. While the data is imperfect, organizations that begin incorporating it into their revenue cycle, patient access, and managed care strategies may be better positioned as the industry moves toward a more data-driven environment.
How Forvis Mazars Can Help With Prior Authorization
Our revenue cycle team helps organizations adapt to prior authorization and interoperability changes and identify opportunities for operational performance improvement. If you have questions about payor prior authorization data and how you can leverage it at your organization, please reach out to our team today.