74 sourced statistics on how much prior authorization there is, how
long it takes, how often it is denied and then reversed, and what
changes under the CMS 2026 rule. Every number traces to a named
primary source.
By Dan Nandan, Founder and CEO, Staffingly, Inc. ·
2026 Edition
Prior authorization in 2024 and 2025, by the numbers
Six findings from the report. Each is dated and linked to its primary
source inside the full report.
53M
Medicare Advantage prior authorization requests in 2024, and that
is one program alone.
KFF 2024
13 hrs
Per physician per week on prior authorization, at about 40
requests each week.
AMA 2025
80.7%
Of appealed Medicare Advantage denials were overturned, yet only
11.5% were appealed.
KFF 2024
13%
Of denied prior authorization requests actually met Medicare
coverage rules.
HHS OIG
26%
Of physicians reported a prior-authorization-linked serious
adverse event for a patient.
AMA 2025
2026
CMS rule requires 72-hour and 7-day decisions; the enabling APIs
are due by 2027.
CMS-0057-F
Bottom line: prior authorization is high in volume, heavy in
staff time, and often reversed on appeal yet rarely appealed, and the
2026 CMS rule speeds decisions without reducing the work.
A key-findings dashboard and hand-built
charts across 10 chapters
The Prior Authorization Complexity
framework across six workflow dimensions
A methodology and limitations note,
numbered sources, and a machine-readable data appendix
What each finding means for a practice
on Monday morning
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74 statistics, every one
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Sourced from CMS, the AMA, KFF, the HHS OIG, MGMA, CAQH, and Health
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About the data: every figure in this report is drawn from the named
primary source cited alongside it, including KFF, the American Medical
Association, the HHS Office of Inspector General, CMS, CAQH, MGMA, and
Health Affairs. Staffingly, Inc. compiled and summarized these figures and
does not claim ownership of the underlying data. This material is provided
for general informational purposes only and is not legal, clinical,
financial, or compliance advice.
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