62 of 254 payers publish their full prior-auth rules

Ask for the rule behind a prior-auth denial and most payers cannot show it: Nirmitee's mid-September review of 254 plans found 73 publishing no criteria, only a code list and a vendor name. The decisions live in licensed InterQual or MCG libraries that nobody outside can read.

From January 1, 2027, the CMS prior authorization rule requires impacted payers to expose their documentation requirements through an API, so the closed tier must write its rules down or renegotiate its vendor contracts.