Changing the way you
receive healthcare
Prior Authorization Metrics
PHP in alignment with the CMS Interoperability and Prior Authorization final rule, publishes an annual summary report of our prior authorization metrics. This report reflects the prior authorization activity for medical services (excluding prescription drugs) for the previous calendar year.
The intention of this report is to provide transparency, a better understanding of the authorization process and to enable providers to evaluate payer performance.
Prior Authorization Timeframes
- Before January 1, 2026, Medicare Advantage plans were required to issue prior authorization decisions within 72 hours for expedited requests (urgent) and 14 calendar days for standard requests (non-urgent).
- Beginning January 1, 2026, updated federal standards require Medicare Advantage plans to send prior authorization decisions within 72 hours for expedited requests and 7 calendar days for standard requests.
- Before January 1, 2026, Medicare Advantage plans were required to issue prior authorization decisions within 72 hours for expedited requests (urgent) and 14 calendar days for standard requests (non-urgent).
For additional information or if there are any questions on prior authorizations or the above metrics, please contact the Utilization and Case Management Department at (800) 474-1434, Monday through Friday, 8:30 a.m. to 5:30 p.m. (TTY 711).
You will need the Adobe Acrobat Reader program to view the above forms. To download this free program click here or use the link above – the link will open a new window and take you to the Adobe website.
Page Updated: March 31, 2026 @ 10:58pm