Payer Transparency Tracker

CMS-0057-F Compliance Scorecard

The March 31, 2026 deadline has passed. Payers were required to publicly report prior authorization metrics under CMS-0057-F. We checked every impacted payer in the United States. The results are not encouraging.

Read the Analysis → Join the Pilot
86% NON-COMPLIANT
1,296 PAYERS ASSESSED
UPDATED APRIL 2026
Payers Assessed
1,296
100% of impacted payers
Compliance Rate
9%
Grade C or better
Grade A
7
Full machine-readable data
Grade F
1114
No evidence of compliance
Grade Distribution
A
7 (1%)
B
110 (8%)
C
0 (0%)
D
65 (5%)
F
1114 (86%)
By Payer Type
TypeTotalPassingRate
Medicare Advantage975727%
Medicaid MCO3000%
Medicaid FFS5647%
CHIP5148%
Qualified Health Plan1843720%
Payer Scorecard
Showing 1,296 payers
PayerTypeStateEnrolledMetricsGrade
Wellcare (S4802)MA-8.9M0/3F
Aetna Medicare (S5601)MA-4.2M0/3F
Humana (S5884)MA-3.8M0/3F
Humana (H5216)MA-2.7M0/3F
Centene / Sunshine Health (FL)Medicaid MCOFL2.5M0/3F
L.A. Care Health Plan (CA)Medicaid MCOCA2.4M0/3F
UnitedHealthcare Community Plan (NY)Medicaid MCONY2.2M0/3F
Fidelis Care (NY)Medicaid MCONY2.1M0/3F
Centene / Ambetter (TX)Medicaid MCOTX2.0M0/3F
Molina Healthcare (CA)Medicaid MCOCA1.9M0/3F
Aetna Medicare (H5522)MA-1.8M0/3F
UnitedHealthcare Community Plan (TX)Medicaid MCOTX1.8M0/3F
Health Net (Centene) (CA)Medicaid MCOCA1.8M1/3D
Healthfirst (NY)Medicaid MCONY1.8M0/3F
HealthSpring (S5617)MA-1.7M0/3F
Centene / Peach State (GA)Medicaid MCOGA1.5M0/3F
CareSource (OH)Medicaid MCOOH1.5M0/3F
Inland Empire Health Plan (CA)Medicaid MCOCA1.5M0/3F
Kaiser Permanente (H0524)MA-1.4M0/3F
Humana (H7617)MA-1.2M0/3F
UnitedHealthcare Community Plan (OH)Medicaid MCOOH1.2M0/3F
Molina Healthcare (TX)Medicaid MCOTX1.1M0/3F
Aetna Medicare (H5521)MA-1.1M0/3F
Express Scripts Medicare (S5660)MA-1.0M0/3F
Anthem / Elevance (Medicaid) (IN)Medicaid MCOIN1.0M0/3F
WellCare (Centene) (FL)Medicaid MCOFL1.0M1/3D
Blue Cross Blue Shield Association (S2135)MA-933K0/3F
Anthem / Elevance (Medicaid) (VA)Medicaid MCOVA900K0/3F
CalOptima (CA)Medicaid MCOCA900K0/3F
Humana (H1036)MA-837K0/3F
Molina Healthcare (OH)Medicaid MCOOH800K0/3F
Anthem / Elevance (Medicaid) (GA)Medicaid MCOGA800K0/3F
AmeriHealth Caritas (PA)Medicaid MCOPA800K0/3F
Anthem Blue Cross and Blue Shield (H4036)MA-707K0/3F
Aetna Better Health (PA)Medicaid MCOPA700K0/3F
WellCare (Centene) (GA)Medicaid MCOGA700K1/3D
MetroPlus (NY)Medicaid MCONY700K0/3F
Blue Cross Blue Shield of Michigan (H9572)MA-610K0/3F
Aetna Better Health (NJ)Medicaid MCONJ600K0/3F
HealthSpring (S5715)MA-532K0/3F
Humana (H5619)MA-508K0/3F
1 / 26
Methodology

Data sources: CMS CPSC Monthly Enrollment (March 2026), QHP Plan Attributes PUF (PY2026), ONC Lantern FHIR Endpoint Directory, state Medicaid agency websites.

Metrics scoring (0-3): 0 = no PA metrics found, 1 = minimal PA content, 2 = PA metrics published (PDF or partial), 3 = full machine-readable metrics.

Grading: Weighted average of metrics reporting (70%) and FHIR readiness (30%). A = 2.5+, B = 2.0+, C = 1.5+, D = 1.0+, F = below 1.0.

Scores reflect what is publicly discoverable via automated web crawling. Payers may have published data in locations not covered by our checks. Last updated: 2026-04-06.