PRIOR AUTHORIZATION METRICS FOR MEDICAL ITEMS AND SERVICES (EXCLUDING DRUGS)
PRIOR AUTHORIZATION METRICS FOR MEDICAL ITEMS AND SERVICES (EXCLUDING DRUGS)
To comply with the CMS Interoperability and Prior Authorization Final Rule, GlobalHealth 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, appeals, and related outcomes) 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, these metrics may be used to compare plans, programs, and payers.
GlobalHealth – Utilization Management
Email: [email protected]
Tel/Direct: 954-263-7503
Reporting Period: Calendar Year 2025
Standard (non-urgent) Prior Authorization Requests
| How many times this happened | Out of total requests | Percentage | |
|---|---|---|---|
| Request approved | 76,264 | 77,229 | 98.75% |
| Request denied | 965 | 77,229 | 1.25% |
| How many times this happened | Out of total requests | Percentage | |
|---|---|---|---|
| Request approved within 7 days | 70,125 | 77,229 | 90.80% |
| Request denied within 7 days | 798 | 77,229 | 1.03% |
| How many times this happened | Out of total requests | Percentage | |
|---|---|---|---|
| Request approved only after time for review was extended* | 0 | 77,229 | 0% |
| Request denied after time for review was extended | 0 | 77,229 | 0% |
| How many times this happened | Out of total appeals | Percentage | |
|---|---|---|---|
| Request approved only after appeal | 52 | 103 | 50.49% |
| Request denied after appeal | 51 | 103 | 49.51% |
Expedited (urgent) Prior Authorization Requests
(Response Due to Provider Within 72 Hours)
| How many times this happened | Out of total requests | Percentage | |
|---|---|---|---|
| Request approved | 1,240 | 1,300 | 95.38% |
| Request denied | 60 | 1,300 | 4.62% |
| How many times this happened | Out of total requests | Percentage | |
|---|---|---|---|
| Request approved within 72 hours | 1,180 | 1,300 | 90.77% |
| Request denied within 72 hours | 55 | 1,300 | 4.23% |
| How many times this happened | Out of total requests | Percentage | |
|---|---|---|---|
| Request approved only after time for review was extended* | 15 | 1,300 | 1.15% |
| (optional) Request denied after time for review was extended | 5 | 1,300 | 0.38% |
| How many times this happened | Out of total appeals | Percentage | |
|---|---|---|---|
| Request approved only after appeal | 8 | 20 | 40% |
| Request denied after appeal | 12 | 20 | 60% |
*As permitted by CMS, reporting extended-timeframe metrics separately for standard and expedited prior authorization requests is optional.
| How many times this happened | Out of total appeals | Percentage | |
|---|---|---|---|
| Request approved only after appeal | 0 | 0 | 0 |
| Request denied after appeal | 0 | 0 | 0 |
Time Between Receiving a Prior Authorization Request and Sending a Decision
| Mean (Average) Time | Median (Middle) Time | |
|---|---|---|
| Standard (non-urgent) Prior Authorization Requests (response due to provider within 7 calendar days) | 5 Days | 4 Days |
| Expedited (urgent) Prior Authorization Requests (response due to provider within 72 hours) | 1 Day | 1 Day |
Metrics exclude prescription drugs and are reported in accordance with CMS Interoperability and Prior Authorization requirements.
