Medi-Cal Fee-for-Service Prior Authorization Metrics Reporting

DHCS is required to annually report aggregated Medi-Cal and Children’s Health Insurance Program (CHIP) fee-for-service (FFS) prior authorization metrics to comply with the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F). Publicly reporting these metrics promotes transparency and accountability, helps Medi-Cal and CHIP FFS members understand prior authorization processes, and enables providers and stakeholders to evaluate payer performance and administrative efficiency. The reporting includes access to information for all Medi-Cal and CHIP FFS items and services (excluding drugs) that require prior authorization, as well as data on prior authorization requests for those items and services over the previous calendar year.

Please contact the DHCS Interoperability team with any questions or comments on the prior authorization metrics reports at interoperability@dhcs.ca.gov.

2025 Prior Authorization Metrics Reports

• Medi-Cal – 2025 Prior Authorization Metrics for Medi-Cal Fee-for-Service Medical and Behavioral Health Items and Services
• Medi-Cal Dental – 2025 Prior Authorization Metrics for Medi-Cal Fee-for-Service Dental Items and Services
• California Children’s Services – 2025 Prior Authorization Metrics for California Children’s Services (CCS) Items and Services