To comply with the CMS Interoperability and Prior Authorization final rule, HealthTeam Advantage 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. For questions on the data below, contact our Utilization Management Team via email, UM-team@htanc.com.
Reporting Period: 2025
These are the medical items and services for which we require prior authorization (excluding drugs):
Beginning January 1, 2026, the CMS Interoperability and Prior Authorization final rule requires Medicare Advantage plans to send prior authorization decisions within:
- 72 hours for expedited requests (urgent)
- 7 calendar days for standard requests (non-urgent)