We require authorization for certain drugs, services and procedures. In these cases, providers will submit clinical documentation and medical records demonstrating that the drug, service or procedure is medically necessary.
Prior authorization metrics
To comply with the CMS Interoperability and Prior Authorization final rule, Priority Health is required to annually report aggregated prior authorization metrics on our website. This includes a list of all medical items and services (excluding drugs) that require prior authorization - which we call our Authorization Quick Reference List - as well as data on prior authorization requests for those items and services (i.e., approvals, denials, etc.) over the previous calendar year.Use the links below to access prior authorization metrics for 2025 medical items and services by product:
Notice of Admission requirement
Effective Sept. 1, 2026, we’ll require Notice of Admission (NOA) for hospital inpatient admissions for all plan types (commercial, Medicaid and Medicare), for medical admissions only. NOA is separate from and in addition to authorization requirements.
Facilities will be required to notify Priority Health within 24 hours of a hospital inpatient admission (or within one business day).