CMS-0057 & Policy
Prior Authorization Metrics (Public Reporting)
Draft — pending verification
This reference entry has not yet been verified against its authoritative source (Original definitions; regulatory facts to be verified against CMS-0057-F (89 FR 8758) and X12/HL7 documentation). Do not rely on it for production configuration until this notice is removed.
In more depth
This is the rule's transparency lever: standardized, public, annual numbers that regulators, journalists, and competitors can compare. Producing them defensibly requires clean determination data — consistent definitions of received, decided, denied, appealed — which is a data-engineering project most payers underestimated.