Prior Authorization Metrics for Medical Items and Services

To comply with the Centers for Medicare & Medicaid Services (CMS) Interoperability and Prior Authorization final rule, Jai Medical Systems Managed Care Organization, Inc. (JMS) is required to annually report aggregated prior authorization metrics. Specifically, these metrics  include a list of all medical items and services (excluding drugs) that require prior authorization, as well as data on prior authorization requests for those items and services (e.g., approvals, denials, etc.) over the previous calendar year. Public reporting these metrics promotes transparency and accountability, helps patients understand prior authorization processes, and enables providers to evaluate payer performance. In addition, metrics can be used to compare plans, programs, and payers.

For questions on the data below, please contact:
Utilization Management Department

Phone: 1-888-JAI-1999 (1-888-524-1999)

Reporting Period: January 1, 2025 – December 31, 2025

Prior Authorization Decision Timeframes

Beginning January 1, 2026, the CMS Interoperability and Prior Authorization final rule requires Medicaid managed care plans to send prior authorization decisions within:

1. Within 24 hours of receipt of information or 72 hours for expedited requests when information is not received (urgent)
2. Within 2 business days of receipt of information or 7 calendar days for standard requests when information is not received (non-urgent)

Medical Items and Services Requiring Prior Authorization (Excluding Drugs)

Please note, some medical items and services require prior authorization at JMS. For the complete current list, please visit: Services and procedures requiring prior authorization.

Standard (Non-Urgent) Prior Authorization Requests

Expedited (Urgent) Prior Authorization Requests

Time Between Receiving a Prior Authorization Request and Sending a Decision