To comply with the Centers for Medicare & Medicaid Services CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F), the Indiana Health Coverage Programs (IHCP) is required to report aggregated prior authorization metrics for the calendar year. This includes publishing a list of all medical services and items (excluding drugs) that require prior authorization, as well as data on prior authorization requests for those services and items (such as approvals, denials, and so on) over the previous calendar year.
Publicly 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 managed care programs (Healthy Indiana Plan, Hoosier Healthwise, Hoosier Care Connect and Indiana PathWays for Aging [PathWays]), prior authorization metrics are required to be reported on each managed care entity’s website.
For fee-for-service (FFS) Medicaid programs and FFS Children’s Health Insurance Program (CHIP), these prior authorization metrics are reported to the IHCP by the FFS prior authorization and utilization management (PA-UM) contractor, Acentra Health.
The Acentra Health: 2025 Prior Authorization Metrics Report (linked below) presents the performance of Acentra Health in handling PA requests for the IHCP during calendar year 2025. Similar reports will be published annually.
Acentra Health:
2025 Prior Authorization Metrics Report
Providers can check the Professional Fee Schedule and Outpatient Fee Schedule to see which medical items and services require prior authorization for FFS coverage. Those fee schedules are accessible from the IHCP Fee Schedules page.
For questions on these prior authorization metrics, contact Acentra Health Customer Support at 866-725-9991. Providers can also check the Prior Authorization provider reference module and other service-specific provider reference modules for more information about IHCP FFS prior authorization policies and procedures.
Required Time Frames for Prior Authorization Decisions
The CMS establishes time frames within which certain agencies must return prior authorization decisions. The following sections show the time frames that impact the IHCP, both prior to and after 2026.
Prior to 2026
Prior to Jan. 1, 2026, impacted payers were required to send prior authorization decisions within the following time frames:
- For state Medicaid FFS programs:
- For expedited requests (nonurgent) – No required decision time frame
- For standard requests (nonurgent) – No required decision time frame
- For state Children’s Health Insurance Program (CHIP) FFS programs:
- For expedited requests (nonurgent) – No required decision time frame
- For standard requests (nonurgent) – 14 days
- For Medicaid managed care plans and CHIP managed care entities:
- For expedited requests (urgent) – 72 hours
- For standard requests (nonurgent) – 14 calendar days
Starting in 2026
Beginning Jan. 1, 2026, the CMS Interoperability and Prior Authorization Final Rule requires that PA decisions for all state Medicaid and CHIP agencies be sent within the following time frames:
- For expedited requests (urgent) – 72 hours
- For standard requests (nonurgent) – Seven calendar days