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Prior Authorization Metric Reporting

To comply with the CMS Interoperability and Prior Authorization final rule, Ultimate Health Plan 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. Public 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: Ultimate Health Plans Toll-Free:1-844-891-2121 (TTY 771) Monday - Friday, 8 am - 8 pm

Reporting Period: 2025

Scorecard for Year 2025 Result
The percentage of prior standard authorization requests that were approved, aggregated for all items and services 97.10%
The percentage of standard prior authorization requests that were denied, aggregated for all items and services 2.90%
The percentage of standard prior authorization requests that were approved after appeal, aggregated for all items and services 55%
The percentage of expedited prior authorization requests that were approved, aggregated for all items and services 97.82%
The percentage of expedited prior authorization requests that were denied, aggregated for all items and services 2.18%
The average time that elapsed between the submission of a request and a determination for standard prior authorizations, aggregated for all items and services Same Day
The median time that elapsed between the submission of a request and a determination for standard prior authorizations, aggregated for all items and services Same Day
The average time that elapsed between the submission of a request and a decision for expedited prior authorizations, aggregated for all items and services 2.6 Hours
The median time that elapsed between the submission of a request and a decision for expedited prior authorizations, aggregated for all items and services 0.5 Hours