Prior Authorization Metrics Reporting

To comply with the Centers for Medicare and Medicaid Service (CMS) Interoperability and Prior Authorization final rule, Blue Cross and Blue Shield of Alabama 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.