Reporting
CMS-0057-F imposes two distinct annual reporting obligations on impacted payers. Both have the same first-report deadline: March 31, 2026 (covering CY 2025).
Public prior-authorization metrics
Posted on a publicly accessible page of the payer's website, no login. Excludes drugs.
| Property | Value |
|---|---|
| First report due | March 31, 2026 |
| First report covers | Calendar year 2025 |
| Cadence | Annually, by March 31, covering the prior calendar year |
| Where | Publicly accessible page on the payer's own website |
| Drugs | Excluded |
Required metrics
Aggregated across all items and services the payer requires prior authorization for:
| Metric | Description |
|---|---|
| List of items and services requiring prior authorization | Publicly enumerated, excluding drugs |
| Percent approved | Of all prior-authorization requests submitted |
| Percent denied | Of all prior-authorization requests submitted |
| Percent approved after appeal | Of denials that the member or provider appealed |
| Average decision time — standard requests | From submission to determination |
| Median decision time — standard requests | From submission to determination |
| Average decision time — expedited requests | From submission to determination |
| Median decision time — expedited requests | From submission to determination |
Confidential Patient Access API metrics
Reported privately to CMS as aggregated, de-identified data — not posted publicly.
| Property | Value |
|---|---|
| First report due | March 31, 2026 |
| First report covers | Calendar year 2025 |
| Cadence | Annually |
| Where | To CMS, in aggregated de-identified form |
Required metrics
| Metric | Description |
|---|---|
| Unique patients whose data was transferred via the Patient Access API | To a health app designated by the patient |
| Unique patients whose data was transferred more than once | To a health app designated by the patient |
Who reports
| Payer type | Reports? |
|---|---|
| Medicare Advantage | ✓ |
| Medicaid Fee-for-Service | ✓ |
| Medicaid managed care plans | ✓ |
| CHIP Fee-for-Service | ✓ |
| CHIP managed care entities | ✓ |
| QHP issuers on the FFE | ✓ |
What Payerbox provides
Payerbox stores prior-authorization request and decision history through the PAS flow as Claim (request), ClaimResponse (decision), and Task (status) resources. Aggregating those into the metric set above is a payer-side reporting query — Payerbox does not publish the metrics for the payer, but holds the data needed to compute them.