What the CMS-0057-F Disclosures Reveal About Commercial Payers in 2026

Under the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F), calendar year 2025 compliance data became public in March 2026. The findings analyzed by KFF in August 2026 confirm what revenue cycle teams have known for years: denial rates are staggering, but appeals win far more often than insurers want providers to realize.

UnitedHealth Group denied 17% of all standard Medicare Advantage prior-auth requests, while Elevance denied just 5%. Even more striking are the overturn rates: Centene overturned an astonishing 93% of appealed denials, while CVS Health overturned 89%.

This variance proves that a denial is not a final clinical judgement — it is an administrative hurdle designed to filter out providers who lack the labor hours to submit an appeal.