Prior Authorization Metrics for Medical Items and Services (excluding drugs)

To comply with the CMS Interoperability and Prior Authorization final rule Alliance Health 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. Questions on the data below can be directed to Alliance Member and Recipients at 800-510-9032.

The Alliance Procedure Code Lookup Tool details the medical items and services for which we require prior authorization.

Prior to January 1, 2026, impacted payers are required to send prior authorization decisions within the following timeframes:

• For Medicaid managed care plans and CHIP managed care entities, 72 hours for expedited requests (urgent) and 14 calendar days for standard requests (non-urgent)

Non-Urgent Prior Authorization Requests
(Response due to provider within 14 calendar days)

Urgent Prior Authorization Requests
(response due to provider within 72 hours)

Non-Urgent Prior Authorization Request Appeals

Urgent Prior Authorization Request Appeals

Non-Urgent Prior Authorization Request Time
Time between receiving a prior authorization request and sending a decision

Urgent Prior Authorization Requests Time
Time between receiving a prior authorization request and sending a decision