How Long Prior Authorization Takes at Major Payers

A typical prior authorization request for a medical service now gets a decision in about a day. That was the 2025 median for standard requests at the largest Medicare Advantage, Medicaid managed care and ACA marketplace insurers. The figures come from KFF's analysis of the metrics insurers now have to post. The median expedited request in Medicare Advantage took just under 10 hours.

The legal deadline is much longer, and it depends on the plan. Starting in 2026, Medicare Advantage and Medicaid have 7 calendar days to decide a standard request for a medical service under CMS-0057-F. Marketplace and employer plans still have 15 days. Federal law sets 72 hours for an expedited, or urgent, request in all of them. Your practice works between those two clocks: the day a typical request takes, and the deadline a slow one can run to.

Prior authorization turnaround times by insurer: the 2025 data

At the largest insurers, the median standard prior authorization request took 1 day in Medicare Advantage and Medicaid managed care. In the marketplace, it took 0.9 days, just under 22 hours. Expedited requests took a median of 0.4 days in Medicare Advantage, 0.8 days in Medicaid managed care and 1 day in the marketplace. KFF compiled the reports of 14 large insurers covering about 71 million enrollees. The marketplace figures cover the 28 states on the federally facilitated marketplace in 2025.

CMS-0057-F, the Interoperability and Prior Authorization final rule, required Medicare Advantage, Medicaid, CHIP and federal marketplace insurers to post those 2025 metrics by March 31, 2026. Medicare Advantage plans had reported prior authorization data to CMS for years, KFF notes. Now each insurer publishes its own numbers, response times included. The next Medicare Advantage reports are due by March 31, 2027, under 42 CFR 422.122. They will cover 2026, the first year of the 7-day limit.

In KFF's figures, medians varied more between insurers than between markets. In Medicare Advantage, standard medians ran from under 1 day at CVS Health's Aetna, Humana and Kaiser Permanente to 2 days at Centene. In Medicaid managed care, they ran from 1 day at Centene, Elevance Health and Molina Healthcare to 4 days at CareSource. In the marketplace, they ran from under 1 day at UnitedHealth Group, GuideWell and Health Care Service Corporation to 4 days at Molina Healthcare.

A median hides the slow requests. By definition, half of each insurer's requests took at least as long as its median. For decision times, insurers have to report only medians and averages, so the required data shows no tail and no count of requests that ran past the deadline. They do not report times by service either, so a request for advanced imaging and a request for physical therapy land in the same number. KFF flags both gaps. The reports also leave out prescription drugs.

The legal deadline for a prior authorization decision, by plan type

A Medicare Advantage plan has 7 calendar days to decide a standard request for a service that needs prior authorization, under 42 CFR 422.568. An expedited request gets 72 hours, under 42 CFR 422.572. The plan can extend either clock by up to 14 calendar days in some cases. Those include the patient asking for more time, or the plan needing records from an out-of-network provider that could change a denial. If the plan misses its deadline, the regulation treats that as an adverse decision, which you can appeal. A request for a Part B drug gets 72 hours, or 24 hours if expedited, and the plan cannot extend either one.

Medicaid moved to the same 7 days and 72 hours, and a state can set shorter limits. A Medicaid managed care plan must meet the state's timeframe, which cannot exceed 7 calendar days, under 42 CFR 438.210. The limit applies from the plan's first rating period that starts on or after January 1, 2026. Fee-for-service Medicaid uses 7 days unless state law sets a shorter limit, under 42 CFR 440.230.

Marketplace and employer plans run on an older clock, because CMS-0057-F left their timeframes alone. A marketplace plan, like an employer plan, has 15 days to decide a standard request before care. It can extend once by up to 15 days, for matters beyond its control and with notice before day 15. An urgent request gets 72 hours. Both limits come from the Department of Labor's claims procedure regulation, 29 CFR 2560.503-1, and 45 CFR 147.136 extends it to individual market plans, marketplace plans included. A CMS proposal from April 2026, CMS-0062-P, would move plans on the federal marketplace to 7 days and 72 hours from October 1, 2027. That change is not final.

State prior authorization laws with shorter deadlines

State prior authorization laws can cut the deadline for an urgent request to 24 hours, but only for plans the state regulates. The American Medical Association counted 23 states that passed prior authorization reform laws in 2025. Vermont gives a plan 24 hours to act on an urgent request and 2 business days to approve or deny a complete standard one. A request the plan leaves unanswered past those limits is deemed granted. Indiana allows 24 hours for an urgent request and 48 hours for any other, and neither clock counts weekends or holidays.

Those laws stop at Medicare Advantage and at self-funded employer plans. Federal Medicare Advantage standards supersede state law, apart from state licensing and solvency laws. ERISA keeps most state insurance laws from applying to self-funded employer plans. Check whether a plan is Medicare Advantage, fully insured or self-funded before you count days.

Prior authorization denials and the time an appeal adds

A fast answer can still be a denial. In the same KFF data, standard-request denial rates in Medicaid managed care ranged from 2% at L.A. Care Health Plan to 23% at Independence Health Group. Our post on why prior authorization approval does not guarantee payment covers the denial rates in each market, and how often appeals overturned those denials.

An appeal adds its own clock. A Medicare Advantage plan has 30 calendar days to decide a standard appeal of a denied service and 72 hours for an expedited one, under 42 CFR 422.590. A Medicaid managed care plan answers to state limits of no more than 30 calendar days and 72 hours, under 42 CFR 438.408. Either plan can extend by up to 14 days in some cases. Marketplace plans, and employer plans with one level of appeal, have 30 days for a pre-service appeal and 72 hours for an urgent one, under the claims procedure regulation.

Most denials never reach that clock. KFF found that prior authorization denials are rarely appealed. The AMA's 2025 survey of 1,000 physicians, fielded in December 2025, found that 21% always appeal an adverse prior authorization decision. Asked why they do not appeal, physicians gave three main reasons. They expect the appeal to fail, based on past experience (59%). They lack the staff time (52%). Or the patient's care cannot wait for the plan (49%).

Why prior authorization looks fast in the data and slow in practice

KFF says the short medians likely reflect, at least in part, the increasing use of technology in prior authorization, such as artificial intelligence and electronic prior authorization systems. Insurers report fast numbers of their own. UnitedHealthcare says around 92% of the authorizations submitted to it are approved, in less than 24 hours on average. Under the insurers' June 2025 pledge, covered below, plans aim to answer at least 80% of electronic approvals with all needed clinical documentation in real time in 2027.

Physicians describe a heavy load. In the AMA's survey, practices completed an average of 40 prior authorizations per physician each week, which took 13 hours of physician and staff time. Nearly one in three physicians, 32%, said requests are often or always denied. Three in four, 74%, said denials have increased over the past five years. And 95% said prior authorization delays access to necessary care.

The delays reach patients. In the same survey, 26% of physicians said prior authorization had led to a serious adverse event for a patient in their care. Physicians also reported hospitalizations (20%) and life-threatening events or interventions to prevent permanent impairment (22%). And 8% reported a disability, permanent bodily damage, a birth defect or a death.

The June 2025 insurer pledge on prior authorization

On June 23, 2025, dozens of health insurers signed a set of commitments to simplify prior authorization, announced by AHIP and the Blue Cross Blue Shield Association. The signers include UnitedHealthcare, CVS Health's Aetna, The Cigna Group, Elevance Health, Humana, Kaiser Permanente, Centene and many Blue Cross Blue Shield plans. AHIP said the commitments would benefit 257 million Americans. Each plan committed to cutting medical prior authorizations by January 1, 2026, and the signers as a group committed to the 2027 real-time target.

AHIP's first progress update, in April 2026, said plans had eliminated 11% of prior authorizations across a range of medical services, or 6.5 million fewer requests. That included a reduction of more than 15% in Medicare Advantage. The figures are the plans' own estimates for their fully insured commercial, Medicare Advantage and ACA plans. Each plan counted how many of its 2024 requests involved the codes it had since dropped, AHIP's fact sheet explains. In September 2026, AHIP and the Blue Cross Blue Shield Association published clinical documentation standards covering prior authorization for 66 medical services. Adoption is voluntary, and implementation is targeted for January 1, 2027.

UnitedHealthcare made its own cut in 2026. Beginning October 1, 2026, it is eliminating 30% of its prior authorization requirements for its commercial, Medicare Advantage, Individual Exchange and Oxford plans. Its Medicaid Community Plans are getting the cut state by state. Arizona, New Mexico, New York and Ohio follow on November 1, 2026, and Missouri and Washington on December 1.

The AMA's December 2025 survey came before the pledge's first major deadline, and physicians were skeptical. The AMA wrote that the impact of the commitments "has not yet materialized," and only 33% of physicians said they believe the pledge will make a meaningful difference. Physicians have seen announced cuts before. UnitedHealthcare and Cigna reduced their prior authorization lists in 2023. Only 16% of physicians who work with UnitedHealthcare said the change reduced the prior authorizations they complete, according to the AMA's 2024 survey. The figure for Cigna was also 16%.

What decides how long your prior authorization request takes

Three things shape how long a prior authorization request takes: the plan type, the insurer and whether the request is complete. The plan type and state law set the deadline. The insurer sets the typical pace, as the medians above show. And a complete request avoids the delays that come from a plan asking for more information.

The submission channel changes your side of the work. In the 2024 CAQH Index, providers and staff spent an average of 24 minutes on a prior authorization request by phone, fax or email. A request through a health plan portal took 16 minutes, and a fully electronic one took 10. That measures your staff's time, not the payer's decision time, and the metrics insurers post do not split decision times by channel. In the same Index, 22% of medical prior authorizations went in by phone, mail, fax or email, and 35% were fully electronic.

A new channel opens in 2027. CMS-0057-F requires the payers that post these metrics to run a Prior Authorization API from that year. It lets your practice check whether a payer requires prior authorization for a service, see the documentation the payer wants and send the request. It will not add turnaround times by service to the public reports.

So your own log remains the best data on a payer. Record the date you submit each request, the date the plan received it, the date of the decision and any extension notice. The 7-day Medicare Advantage clock and the 15-day marketplace clock both run from the day the plan receives the request, not the day you send it. A median tells you what a typical request takes at that insurer. Your log shows which services and plans run long, and when a plan missed its deadline. If care went ahead before a decision came back, our post on retro authorization covers what happens next.

Altair runs prior authorization as part of the whole revenue cycle. It checks whether each planned service needs authorization and maps the request to the payer's criteria. Then it tracks the decision against the payer's timeline and follows up before the request lapses. If a claim comes back denied, one of Altair's in-house billers works it. Altair keeps what it learns about each payer in the system rather than in a person. The practice owner sees every claim and every dollar as it moves, not in a monthly report. The practice hires no one and manages no one, and it keeps the EMR and clearinghouse it already uses. See how Altair handles prior authorization.

A day is now the median wait. The slow requests decide when your patient gets care and when you can bill for it.

Common questions