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TO: All Providers
RE: Public Posting of Prior Authorization Metrics – CMS
Interoperability and Prior Authorization Final Rule
Effective March 31, 2026, the Alabama Medicaid Agency (Medicaid) will
begin publishing Prior Authorization (PA) metrics on the public website in
accordance with the CMS Interoperability and Prior Authorization Final Rule
(CMS-0057-F).
Under this federal
requirement, state Medicaid programs must publicly report certain performance
metrics related to the processing of non-pharmacy prior authorization requests.
These metrics are intended to increase transparency and accountability regarding
PA decision timelines.
Metrics are reported in
aggregate form only and do not include provider-specific or beneficiary-specific
information.
The PA metrics are updated
annually as required under federal regulations at https://medicaid.alabama.gov/content/2.0_Newsroom/2.9_CMS_Required_Reports/2.9.1_Prior_Authorization_Metrics.aspx.
Providers are encouraged to submit complete and accurate prior
authorization requests with all required supporting documentation to support
timely review and processing.
The Current Procedural
Terminology (CPT) and Current Dental Terminology (CDT) codes descriptors, and
other data are copyright © 2026 American Medical Association
and © 2026 American Dental Association (or such other date publication of CPT and
CDT). All rights reserved. Applicable FARS/DFARS apply.