By Dr. Steve Kim, Valer Co-Founder & Chief Medical Officer
Why patient access teams need real-time prior authorization reporting, not just annual payer data.
The problem: Annual reporting isn’t enough
With the rollout of CMS-0057-F public reporting requirements, payer transparency is top of mind for provider organizations who are eager to reduce their prior auth blind spots. But there’s a fundamental limitation: the data is retrospective.
These reports describe what payers did last year, not what they are doing this week. Every number in those reports is months stale by the time it lands. The delays they capture have already kept patients waiting, the denials have already hit revenue, and the blind spots have already slowed your team down. Additionally, the CMS 0057-F mandate reporting is just simply a single aggregate number and doesn’t tell you enough detail around specific services to be of much use.
The organizations that will outperform in this new environment are not the ones waiting for annual reports. They are the ones building real-time prior authorization reporting infrastructure that fills in the gaps the public reporting leaves behind.
You already have the data. It’s just trapped.
Every step of a prior auth workflow generates information. The problem is not that data is missing. It is that the data lives almost anywhere except where a decision-maker can reach it. Most of it lives in the manual prior authorization workflows that exist outside of your EHRs – in payer web portals, faxes, and phone calls. None of this is well documented and difficult to keep track of. How long did the authorization response take? What was all the back and forth with the payer? We rely on staff to try to document notes the best they can in a note field somewhere in the EHR.
Which payers are slowest on orthopedic surgery cases? Where are submissions stalling before they even get acknowledged? What are the denial reasons and which denials can be appealed? Which ones signal a payer policy change? Without structured visibility, prior auth and downstream denials will always be reactive.
As we noted in our Prior Auth Reckoning series, this is how “status limbo” emerges: cases sitting for days without clear follow-up, while the data that could unstick them sits just out of reach.
How Valer closes the gap with real-time reporting & tracking
Real-time reporting is less about adding dashboards and more about changing what a patient access team can actually do in a given week.
As we point out in our Prior Auth Impact Meter, a standard set of reporting requirements from CMS-0057-F is a good step towards meaningful reform. But if provider organizations want to accomplish the goals above, they will need to take more control of the process.
As CMS-0057-F brings public payer data into the ecosystem for the first time, Valer’s reporting infrastructure positions your team to do something unprecedented: compare your operational reality — in real time — against the public record of payer behavior to hold them accountable to the new turnaround time requirements (72 hours for urgent requests and 7 calendar days for routine requests). Let’s walk through exactly what that looks like in practice, with 4 key transformations for your team.
Transformation #1: Spot patterns before they become problems. Instead of discovering a spike in denials spike 90 days out, teams can monitor submissions throughput and payer approvals/denials, redirects, sites of care, and which codes were approved before they trickle through to the back end and end up in denials, appeals, and re-work. Authorization days out reports can provide a pulse on processes and help mitigate services from happening without an auth on file.
Valer’s payer performance dashboard gives patient access leaders a view of how each payer in the platform is performing against the turnaround time metrics now be required by CMS-0057-F. Because Valer captures this data in real time from your actual submissions and payer response, you are no longer in the dark. Managed care and contracting teams are always interested in having the data in hand to hold payers accountable at the next JOC meeting.
For each payer, your team can track:
- Average/median payer turnaround times, tracked against the 7-day routine or 72-hour for urgent requests
- Payer approval/denial rates by service category and/or CPT codes
Transformation #2: Hold payers accountable with evidence, not anecdotes. When CMS-0057-F public reporting gains attention and teeth over time, Valer will allow you to overlay payer-published data against your own operational metrics. A payer may report an aggregate 7% denial rate for authorizations publicly but you’ll have data from Valer that is more meaningful and insightful for your organization – you may see a 19% denial rate for surgical or chemotherapy authorizations vs. <2% rate for E&Ms. Conversely, we seen one of our clients take data showing >97% approval rate for certain codes to health plans and get them to agree to remove prior authorizations for that service. Gold-carding driven by the provider and not waiting on payers to issue them.
With the rise of gold-carding rules in various states and strong interest from CMS in implementing gold-carding, it is critical to have the data available and at hand to hold payers in compliance with regulations.
The turnaround time requirements in CMS-0057-F will not be self-enforcing. In our experience, it’s required providers to have the data in hand to hold payers accountable. Valer can help with this.
Transformation #3: Manage the team, not just the workqueue. One of the most powerful applications of Valer’s reporting infrastructure is internal workflow analysis: identifying exactly where your team’s prior authorization process may be losing time, and potentially why.
Most patient access teams know, intuitively, that some payers are harder to work with than others. What they often lack is the precision to quantify that difficulty: how much harder? For which services? At which step in the process?
Valer reporting and analytics can surface metrics like order to authorization submission lags by individual staff users, quickly assess authorization throughput, and help identify teams that might be overloaded to make decisions on how to load balance authorizations bottlenecks that lead to access delays or the services being performed without an auth on file.
Team leaders can also access productivity dashboards that show:
- Submission volume by staff member and team, with trend analysis over time
- Auth resolution rates
- Approval rates by submitter: identifying whether specific staff members’ submission patterns are associated with higher or lower approval rates which can inform staff education and training to best practices.
Transformation #4: Translate operations to the boardroom. Leadership is always asking for KPIs and data on your patient access team’s performance when it comes to prior auths. Being able to easily find and produce that data, on demand, with current numbers, is a strategic advantage most systems do not have yet.
To that end, Valer is developing a more executive-focused reporting suite. This suite will produce presentation-ready summaries that translate operational prior auth data into the metrics and narrative that matter at the leadership level, including:
- Organization-level prior auth volume, approval rate, and denial rate trends, benchmarked against prior periods
- Payer performance league table: ranking payers by approval rate, decision speed, and compliance with timeliness standards
- Supporting data on payer metrics for potential escalation
The strategic advantage of real-time data
Public payer data is annual, aggregated, and of limited real actionable value. Your operational data is real-time and needs to be granular. The organizations that build both and develop actionable data are the ones that will pull ahead as the scrutiny of public reporting and accountability ramps up over time.
Valer was built for exactly this moment—giving patient access teams the tools to move from visibility gaps to actionable intelligence.
Schedule a demo to see Valer’s reporting in action →
Frequently Asked Questions About Prior Authorization Documentation
How does CMS-0057-F change prior authorization reporting?
It requires certain payers to publicly report metrics like approval rates, denial rates, and turnaround times. That is a meaningful step toward transparency, but the data is aggregated and published annually, which limits its usefulness for decisions you need to make this week.
What metrics should patient access teams track for prior authorization?
Key prior authorization KPIs include:
- Approval rate (initial and post-appeal)
- Denial rate by payer and service
- Time to decision (standard and urgent)
- Appeal rate and success rate
- Pend rate and resolution time
Tracking these metrics allows teams to identify inefficiencies and improve outcomes.
What should patient access teams track that annual reports will not show?
The gap between what payers report publicly and what your team sees in practice. Payer-specific approval and denial rates by service category, actual turnaround times against the 72-hour and 7-day thresholds, pend rates and resolution times, and where in your workflow time is being lost. Real-time tracking turns those into recoverable operational decisions.
How can providers actually improve prior authorization performance with better reporting?
The fastest gains come from structuring data you already generate. Once submission, decision, and turnaround information is captured in a single record by payer and service category, three things get easier: spotting the payers where your approval rate is lagging, finding the workflow stages where time is leaking, and separating denials that are recoverable from the ones that signal a payer policy shift. Staffing and coaching decisions follow from that visibility, not from intuition. Platforms like Valer automate the capture and keep it real-time. The underlying move is the same: stop managing prior auth on anecdote.
What is the biggest reporting challenge in prior auth today?
Visibility. Most organizations are not short on data. They are short on structured, connected data that can answer a specific question when a director needs an answer. That is the gap real-time reporting is built to close.
