Prior Authorization Metrics

Reports on prior authorization for medical items and services (excluding drugs)

To comply with the Centers for Medicare & Medicaid Services (CMS) Interoperability and Prior Authorization Final Rule (CMS-0057-F), Aspirus Health Plan must report aggregated prior authorization metrics on our website each year. Specifically, this includes a list of all medical items and services (excluding drugs) that need prior authorization, as well as data on prior authorization requests for those items and services (for example, approvals and denials) over the past calendar year. Publicly reporting these metrics offers transparency and accountability, helps patients understand the prior authorization process and lets providers rate payer performance. In addition, metrics can be used to compare plans, programs and payers.

Reporting period: calendar year 2025

Before Jan. 1, 2026, impacted payers must send prior authorization decisions within 72 hours for expedited (urgent) requests and 14 calendar days for standard (non-urgent) requests.

The medical items and services for which we required prior authorization

2025 prior authorization lists

Prior authorization metrics for 2025 medical items and services

Aspirus Health Plan (H6874) (PDF) Coming soon