Annual prior authorization report

Prior authorization metrics for medical items and services (excluding drugs)

To comply with the CMS Interoperability and Prior Authorization Final Rule, Geisinger 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) 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. Metrics can also be used to compare plans, programs and payers. Questions on the data below? Contact [enter contact information]. 

Reporting period: 2025

List of prior authorization items

Find the 2025 list of medical items and services for which we require prior authorization (excluding drugs).

Timeliness

Beginning Jan. 1, 2026, the CMS Interoperability and Prior Authorization final rule requires Medicare Advantage plans, state Medicaid agencies, Medicaid managed care plans, state CHIP agencies and CHIP managed care entities to send prior authorization decisions within: 

• 72 hours for expedited requests (urgent)
• 7 calendar days for standard requests (non-urgent)

Non-urgent prior authorization requests (standard)

Urgent prior authorization requests (expedited)

Response due to provider within 72 hours

Time between receiving a prior authorization request and sending a decision