Prior Authorization Metrics

To comply with the CMS Interoperability and Prior Authorization final rule, Delta Dental is required to annually report aggregated prior authorization metrics on our website. Specifically, this includes a list of all services that require prior authorization, as well as data on prior authorization requests for those items and services (e.g., approvals, denials, etc.) 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.

Reporting Period: January 1, 2025–December 31, 2025

These are the services that require prior authorization:

• D2950: core buildup, including any pins when required
• D2710-D2794: crowns (single restorations only)
• D4341-D4342: periodontal scaling and root planning

Prior to January 1, 2026, Delta Dental was required to send prior authorization decisions within the following timeframes:

• 72 hours for expedited requests (urgent) and 14 calendar days for standard requests (non-urgent)

Beginning January 1, 2026, the CMS Interoperability and Prior Authorization final rule requires Delta Dental to send prior authorization decisions within:

• 72 hours for expedited requests (urgent)
• 7 calendar days for standard requests (non-urgent)

Standard (non-urgent) Prior Authorization Requests

Expedited (urgent) Prior Authorization Requests

Time Between Receiving a Prior Authorization Request and Sending a Decision