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Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-H0609","year":2025,"payer":"UnitedHealthcare","program":"ma","report":"H0609","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicare-Advantage-2025.pdf","readOn":"2026-10-07","stdRequests":705296,"stdApproved":653620,"stdDenied":51676,"stdApprovedPct":92.7,"stdDeniedPct":7.3,"appeals":null,"appealApproved":4355,"appealApprovedPct":81.7,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":96093,"expApproved":92936,"expDenied":3157,"expApprovedPct":96.7,"expDeniedPct":3.3,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-H0624","year":2025,"payer":"UnitedHealthcare","program":"ma","report":"H0624","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicare-Advantage-2025.pdf","readOn":"2026-10-07","stdRequests":10367,"stdApproved":9261,"stdDenied":1106,"stdApprovedPct":89.3,"stdDeniedPct":10.7,"appeals":null,"appealApproved":86,"appealApprovedPct":69.9,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":187,"expApproved":153,"expDenied":34,"expApprovedPct":81.8,"expDeniedPct":18.2,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-H0710","year":2025,"payer":"UnitedHealthcare","program":"ma","report":"H0710","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicare-Advantage-2025.pdf","readOn":"2026-10-07","stdRequests":3173,"stdApproved":2466,"stdDenied":707,"stdApprovedPct":77.7,"stdDeniedPct":22.3,"appeals":null,"appealApproved":17,"appealApprovedPct":60.7,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":111,"expApproved":106,"expDenied":5,"expApprovedPct":95.5,"expDeniedPct":4.5,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-H0755","year":2025,"payer":"UnitedHealthcare","program":"ma","report":"H0755","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicare-Advantage-2025.pdf","readOn":"2026-10-07","stdRequests":38238,"stdApproved":30240,"stdDenied":7998,"stdApprovedPct":79.1,"stdDeniedPct":20.9,"appeals":null,"appealApproved":297,"appealApprovedPct":63.5,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":2054,"expApproved":1914,"expDenied":140,"expApprovedPct":93.2,"expDeniedPct":6.8,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-H0764","year":2025,"payer":"UnitedHealthcare","program":"ma","report":"H0764","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicare-Advantage-2025.pdf","readOn":"2026-10-07","stdRequests":499,"stdApproved":441,"stdDenied":58,"stdApprovedPct":88.4,"stdDeniedPct":11.6,"appeals":null,"appealApproved":5,"appealApprovedPct":45.5,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":55,"expApproved":50,"expDenied":5,"expApprovedPct":90.9,"expDeniedPct":9.1,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-H1045","year":2025,"payer":"UnitedHealthcare","program":"ma","report":"H1045","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicare-Advantage-2025.pdf","readOn":"2026-10-07","stdRequests":182207,"stdApproved":149689,"stdDenied":32518,"stdApprovedPct":82.2,"stdDeniedPct":17.8,"appeals":null,"appealApproved":2183,"appealApprovedPct":47.5,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":17168,"expApproved":14911,"expDenied":2257,"expApprovedPct":86.9,"expDeniedPct":13.1,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-H1278","year":2025,"payer":"UnitedHealthcare","program":"ma","report":"H1278","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicare-Advantage-2025.pdf","readOn":"2026-10-07","stdRequests":213495,"stdApproved":203873,"stdDenied":9622,"stdApprovedPct":95.5,"stdDeniedPct":4.5,"appeals":null,"appealApproved":1132,"appealApprovedPct":85.8,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":23935,"expApproved":23348,"expDenied":587,"expApprovedPct":97.5,"expDeniedPct":2.5,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-H1285","year":2025,"payer":"UnitedHealthcare","program":"ma","report":"H1285","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicare-Advantage-2025.pdf","readOn":"2026-10-07","stdRequests":21449,"stdApproved":18566,"stdDenied":2883,"stdApprovedPct":86.6,"stdDeniedPct":13.4,"appeals":null,"appealApproved":307,"appealApprovedPct":43.1,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":848,"expApproved":731,"expDenied":117,"expApprovedPct":86.2,"expDeniedPct":13.8,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-H1360","year":2025,"payer":"UnitedHealthcare","program":"ma","report":"H1360","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicare-Advantage-2025.pdf","readOn":"2026-10-07","stdRequests":1935,"stdApproved":1794,"stdDenied":141,"stdApprovedPct":92.7,"stdDeniedPct":7.3,"appeals":null,"appealApproved":8,"appealApprovedPct":57.1,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":306,"expApproved":293,"expDenied":13,"expApprovedPct":95.8,"expDeniedPct":4.2,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-H1537","year":2025,"payer":"UnitedHealthcare","program":"ma","report":"H1537","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicare-Advantage-2025.pdf","readOn":"2026-10-07","stdRequests":17926,"stdApproved":13416,"stdDenied":4510,"stdApprovedPct":74.8,"stdDeniedPct":25.2,"appeals":null,"appealApproved":179,"appealApprovedPct":61.3,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":469,"expApproved":429,"expDenied":40,"expApprovedPct":91.5,"expDeniedPct":8.5,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-H1659","year":2025,"payer":"UnitedHealthcare","program":"ma","report":"H1659","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicare-Advantage-2025.pdf","readOn":"2026-10-07","stdRequests":810,"stdApproved":642,"stdDenied":168,"stdApprovedPct":79.3,"stdDeniedPct":20.7,"appeals":null,"appealApproved":3,"appealApprovedPct":75,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":56,"expApproved":53,"expDenied":3,"expApprovedPct":94.6,"expDeniedPct":5.4,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-H1889","year":2025,"payer":"UnitedHealthcare","program":"ma","report":"H1889","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicare-Advantage-2025.pdf","readOn":"2026-10-07","stdRequests":178418,"stdApproved":147885,"stdDenied":30533,"stdApprovedPct":82.9,"stdDeniedPct":17.1,"appeals":null,"appealApproved":2338,"appealApprovedPct":56.8,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":11081,"expApproved":8766,"expDenied":2315,"expApprovedPct":79.1,"expDeniedPct":20.9,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-H2001","year":2025,"payer":"UnitedHealthcare","program":"ma","report":"H2001","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicare-Advantage-2025.pdf","readOn":"2026-10-07","stdRequests":1854050,"stdApproved":1419305,"stdDenied":434745,"stdApprovedPct":76.6,"stdDeniedPct":23.4,"appeals":null,"appealApproved":17236,"appealApprovedPct":56.9,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":74909,"expApproved":66274,"expDenied":8635,"expApprovedPct":88.5,"expDeniedPct":11.5,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-H2226","year":2025,"payer":"UnitedHealthcare","program":"ma","report":"H2226","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicare-Advantage-2025.pdf","readOn":"2026-10-07","stdRequests":13000,"stdApproved":12447,"stdDenied":553,"stdApprovedPct":95.7,"stdDeniedPct":4.3,"appeals":null,"appealApproved":83,"appealApprovedPct":24.8,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":282,"expApproved":254,"expDenied":28,"expApprovedPct":90.1,"expDeniedPct":9.9,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-H2247","year":2025,"payer":"UnitedHealthcare","program":"ma","report":"H2247","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicare-Advantage-2025.pdf","readOn":"2026-10-07","stdRequests":19397,"stdApproved":17206,"stdDenied":2191,"stdApprovedPct":88.7,"stdDeniedPct":11.3,"appeals":null,"appealApproved":213,"appealApprovedPct":18.8,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":1268,"expApproved":931,"expDenied":337,"expApprovedPct":73.4,"expDeniedPct":26.6,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-H2272","year":2025,"payer":"UnitedHealthcare","program":"ma","report":"H2272","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicare-Advantage-2025.pdf","readOn":"2026-10-07","stdRequests":3200,"stdApproved":2940,"stdDenied":260,"stdApprovedPct":91.9,"stdDeniedPct":8.1,"appeals":null,"appealApproved":33,"appealApprovedPct":41.3,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":343,"expApproved":306,"expDenied":37,"expApprovedPct":89.2,"expDeniedPct":10.8,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-H2292","year":2025,"payer":"UnitedHealthcare","program":"ma","report":"H2292","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicare-Advantage-2025.pdf","readOn":"2026-10-07","stdRequests":280,"stdApproved":248,"stdDenied":32,"stdApprovedPct":88.6,"stdDeniedPct":11.4,"appeals":null,"appealApproved":2,"appealApprovedPct":66.7,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":5,"expApproved":5,"expDenied":0,"expApprovedPct":100,"expDeniedPct":0,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-H2385","year":2025,"payer":"UnitedHealthcare","program":"ma","report":"H2385","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicare-Advantage-2025.pdf","readOn":"2026-10-07","stdRequests":601,"stdApproved":546,"stdDenied":55,"stdApprovedPct":90.8,"stdDeniedPct":9.2,"appeals":null,"appealApproved":7,"appealApprovedPct":87.5,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":31,"expApproved":28,"expDenied":3,"expApprovedPct":90.3,"expDeniedPct":9.7,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-H2406","year":2025,"payer":"UnitedHealthcare","program":"ma","report":"H2406","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicare-Advantage-2025.pdf","readOn":"2026-10-07","stdRequests":416396,"stdApproved":344462,"stdDenied":71934,"stdApprovedPct":82.7,"stdDeniedPct":17.3,"appeals":null,"appealApproved":3735,"appealApprovedPct":62.1,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":32936,"expApproved":30982,"expDenied":1954,"expApprovedPct":94.1,"expDeniedPct":5.9,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-H2445","year":2025,"payer":"UnitedHealthcare","program":"ma","report":"H2445","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicare-Advantage-2025.pdf","readOn":"2026-10-07","stdRequests":18682,"stdApproved":16209,"stdDenied":2473,"stdApprovedPct":86.8,"stdDeniedPct":13.2,"appeals":null,"appealApproved":238,"appealApprovedPct":41.2,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":1270,"expApproved":928,"expDenied":342,"expApprovedPct":73.1,"expDeniedPct":26.9,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-H2509","year":2025,"payer":"UnitedHealthcare","program":"ma","report":"H2509","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicare-Advantage-2025.pdf","readOn":"2026-10-07","stdRequests":19482,"stdApproved":16964,"stdDenied":2518,"stdApprovedPct":87.1,"stdDeniedPct":12.9,"appeals":null,"appealApproved":409,"appealApprovedPct":43.5,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":1829,"expApproved":1508,"expDenied":321,"expApprovedPct":82.4,"expDeniedPct":17.6,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-H2531","year":2025,"payer":"UnitedHealthcare","program":"ma","report":"H2531","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicare-Advantage-2025.pdf","readOn":"2026-10-07","stdRequests":7282,"stdApproved":6829,"stdDenied":453,"stdApprovedPct":93.8,"stdDeniedPct":6.2,"appeals":null,"appealApproved":99,"appealApprovedPct":30,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":83,"expApproved":81,"expDenied":2,"expApprovedPct":97.6,"expDeniedPct":2.4,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-H2582","year":2025,"payer":"UnitedHealthcare","program":"ma","report":"H2582","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicare-Advantage-2025.pdf","readOn":"2026-10-07","stdRequests":86,"stdApproved":79,"stdDenied":7,"stdApprovedPct":91.9,"stdDeniedPct":8.1,"appeals":null,"appealApproved":0,"appealApprovedPct":0,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":1,"expApproved":1,"expDenied":0,"expApprovedPct":100,"expDeniedPct":0,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-H2802","year":2025,"payer":"UnitedHealthcare","program":"ma","report":"H2802","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicare-Advantage-2025.pdf","readOn":"2026-10-07","stdRequests":203602,"stdApproved":161670,"stdDenied":41932,"stdApprovedPct":79.4,"stdDeniedPct":20.6,"appeals":null,"appealApproved":1622,"appealApprovedPct":55.9,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":6875,"expApproved":6022,"expDenied":853,"expApprovedPct":87.6,"expDeniedPct":12.4,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-H3113","year":2025,"payer":"UnitedHealthcare","program":"ma","report":"H3113","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicare-Advantage-2025.pdf","readOn":"2026-10-07","stdRequests":35501,"stdApproved":31985,"stdDenied":3516,"stdApprovedPct":90.1,"stdDeniedPct":9.9,"appeals":null,"appealApproved":557,"appealApprovedPct":58.1,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":2969,"expApproved":2555,"expDenied":414,"expApprovedPct":86.1,"expDeniedPct":13.9,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-H3256","year":2025,"payer":"UnitedHealthcare","program":"ma","report":"H3256","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicare-Advantage-2025.pdf","readOn":"2026-10-07","stdRequests":18400,"stdApproved":16090,"stdDenied":2310,"stdApprovedPct":87.4,"stdDeniedPct":12.6,"appeals":null,"appealApproved":264,"appealApprovedPct":71.4,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":560,"expApproved":437,"expDenied":123,"expApprovedPct":78,"expDeniedPct":22,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-H3307","year":2025,"payer":"UnitedHealthcare","program":"ma","report":"H3307","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicare-Advantage-2025.pdf","readOn":"2026-10-07","stdRequests":647,"stdApproved":507,"stdDenied":140,"stdApprovedPct":78.4,"stdDeniedPct":21.6,"appeals":null,"appealApproved":8,"appealApprovedPct":57.1,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":19,"expApproved":18,"expDenied":1,"expApprovedPct":94.7,"expDeniedPct":5.3,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-H3379","year":2025,"payer":"UnitedHealthcare","program":"ma","report":"H3379","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicare-Advantage-2025.pdf","readOn":"2026-10-07","stdRequests":67401,"stdApproved":52993,"stdDenied":14408,"stdApprovedPct":78.6,"stdDeniedPct":21.4,"appeals":null,"appealApproved":595,"appealApprovedPct":54.5,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":4168,"expApproved":3896,"expDenied":272,"expApprovedPct":93.5,"expDeniedPct":6.5,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-H3387","year":2025,"payer":"UnitedHealthcare","program":"ma","report":"H3387","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicare-Advantage-2025.pdf","readOn":"2026-10-07","stdRequests":40768,"stdApproved":36076,"stdDenied":4692,"stdApprovedPct":88.5,"stdDeniedPct":11.5,"appeals":null,"appealApproved":485,"appealApprovedPct":43.9,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":2379,"expApproved":1565,"expDenied":814,"expApprovedPct":65.8,"expDeniedPct":34.2,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-H3418","year":2025,"payer":"UnitedHealthcare","program":"ma","report":"H3418","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicare-Advantage-2025.pdf","readOn":"2026-10-07","stdRequests":34822,"stdApproved":27490,"stdDenied":7332,"stdApprovedPct":78.9,"stdDeniedPct":21.1,"appeals":null,"appealApproved":286,"appealApprovedPct":56.4,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":1540,"expApproved":1425,"expDenied":115,"expApprovedPct":92.5,"expDeniedPct":7.5,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-H3794","year":2025,"payer":"UnitedHealthcare","program":"ma","report":"H3794","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicare-Advantage-2025.pdf","readOn":"2026-10-07","stdRequests":15127,"stdApproved":13328,"stdDenied":1799,"stdApprovedPct":88.1,"stdDeniedPct":11.9,"appeals":null,"appealApproved":127,"appealApprovedPct":50.6,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":755,"expApproved":416,"expDenied":339,"expApprovedPct":55.1,"expDeniedPct":44.9,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-H3805","year":2025,"payer":"UnitedHealthcare","program":"ma","report":"H3805","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicare-Advantage-2025.pdf","readOn":"2026-10-07","stdRequests":106551,"stdApproved":91067,"stdDenied":15484,"stdApprovedPct":85.5,"stdDeniedPct":14.5,"appeals":null,"appealApproved":884,"appealApprovedPct":62.1,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":7481,"expApproved":7033,"expDenied":448,"expApprovedPct":94,"expDeniedPct":6,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-H4032","year":2025,"payer":"UnitedHealthcare","program":"ma","report":"H4032","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicare-Advantage-2025.pdf","readOn":"2026-10-07","stdRequests":8,"stdApproved":8,"stdDenied":0,"stdApprovedPct":100,"stdDeniedPct":0,"appeals":null,"appealApproved":0,"appealApprovedPct":null,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":null,"expDeniedPct":null,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"No expedited requests are listed for this contract. UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true. No standard appeals (the appeal rate is posted as NaN)."},{"id":"uhc-H4514","year":2025,"payer":"UnitedHealthcare","program":"ma","report":"H4514","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicare-Advantage-2025.pdf","readOn":"2026-10-07","stdRequests":226988,"stdApproved":216138,"stdDenied":10850,"stdApprovedPct":95.2,"stdDeniedPct":4.8,"appeals":null,"appealApproved":1289,"appealApprovedPct":90,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":27662,"expApproved":26724,"expDenied":938,"expApprovedPct":96.6,"expDeniedPct":3.4,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-H4527","year":2025,"payer":"UnitedHealthcare","program":"ma","report":"H4527","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicare-Advantage-2025.pdf","readOn":"2026-10-07","stdRequests":257844,"stdApproved":249139,"stdDenied":8705,"stdApprovedPct":96.6,"stdDeniedPct":3.4,"appeals":null,"appealApproved":1077,"appealApprovedPct":93.7,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":34494,"expApproved":33622,"expDenied":872,"expApprovedPct":97.5,"expDeniedPct":2.5,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-H4604","year":2025,"payer":"UnitedHealthcare","program":"ma","report":"H4604","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicare-Advantage-2025.pdf","readOn":"2026-10-07","stdRequests":88018,"stdApproved":75213,"stdDenied":12805,"stdApprovedPct":85.5,"stdDeniedPct":14.5,"appeals":null,"appealApproved":887,"appealApprovedPct":71,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":8357,"expApproved":7971,"expDenied":386,"expApprovedPct":95.4,"expDeniedPct":4.6,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-H5008","year":2025,"payer":"UnitedHealthcare","program":"ma","report":"H5008","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicare-Advantage-2025.pdf","readOn":"2026-10-07","stdRequests":28492,"stdApproved":24152,"stdDenied":4340,"stdApprovedPct":84.8,"stdDeniedPct":15.2,"appeals":null,"appealApproved":375,"appealApprovedPct":50.3,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":1711,"expApproved":1371,"expDenied":340,"expApprovedPct":80.1,"expDeniedPct":19.9,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-H5253","year":2025,"payer":"UnitedHealthcare","program":"ma","report":"H5253","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicare-Advantage-2025.pdf","readOn":"2026-10-07","stdRequests":643001,"stdApproved":521259,"stdDenied":121742,"stdApprovedPct":81.1,"stdDeniedPct":18.9,"appeals":null,"appealApproved":4686,"appealApprovedPct":55.9,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":22290,"expApproved":19836,"expDenied":2454,"expApprovedPct":89,"expDeniedPct":11,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-H5322","year":2025,"payer":"UnitedHealthcare","program":"ma","report":"H5322","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicare-Advantage-2025.pdf","readOn":"2026-10-07","stdRequests":135667,"stdApproved":123422,"stdDenied":12245,"stdApprovedPct":91,"stdDeniedPct":9,"appeals":null,"appealApproved":1039,"appealApprovedPct":61.6,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":8923,"expApproved":8262,"expDenied":661,"expApprovedPct":92.6,"expDeniedPct":7.4,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-H5420","year":2025,"payer":"UnitedHealthcare","program":"ma","report":"H5420","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicare-Advantage-2025.pdf","readOn":"2026-10-07","stdRequests":13287,"stdApproved":11850,"stdDenied":1437,"stdApprovedPct":89.2,"stdDeniedPct":10.8,"appeals":null,"appealApproved":178,"appealApprovedPct":21.1,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":2644,"expApproved":2348,"expDenied":296,"expApprovedPct":88.8,"expDeniedPct":11.2,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-H5435","year":2025,"payer":"UnitedHealthcare","program":"ma","report":"H5435","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicare-Advantage-2025.pdf","readOn":"2026-10-07","stdRequests":82,"stdApproved":64,"stdDenied":18,"stdApprovedPct":78,"stdDeniedPct":22,"appeals":null,"appealApproved":1,"appealApprovedPct":33.3,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":7,"expApproved":7,"expDenied":0,"expApprovedPct":100,"expDeniedPct":0,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-H5652","year":2025,"payer":"UnitedHealthcare","program":"ma","report":"H5652","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicare-Advantage-2025.pdf","readOn":"2026-10-07","stdRequests":3326,"stdApproved":3285,"stdDenied":41,"stdApprovedPct":98.8,"stdDeniedPct":1.2,"appeals":null,"appealApproved":2,"appealApprovedPct":15.4,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":24,"expApproved":21,"expDenied":3,"expApprovedPct":87.5,"expDeniedPct":12.5,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-H6595","year":2025,"payer":"UnitedHealthcare","program":"ma","report":"H6595","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicare-Advantage-2025.pdf","readOn":"2026-10-07","stdRequests":11208,"stdApproved":9415,"stdDenied":1793,"stdApprovedPct":84,"stdDeniedPct":16,"appeals":null,"appealApproved":202,"appealApprovedPct":46.8,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":740,"expApproved":638,"expDenied":102,"expApprovedPct":86.2,"expDeniedPct":13.8,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-H6706","year":2025,"payer":"UnitedHealthcare","program":"ma","report":"H6706","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicare-Advantage-2025.pdf","readOn":"2026-10-07","stdRequests":133,"stdApproved":119,"stdDenied":14,"stdApprovedPct":89.5,"stdDeniedPct":10.5,"appeals":null,"appealApproved":4,"appealApprovedPct":100,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":4,"expApproved":4,"expDenied":0,"expApprovedPct":100,"expDeniedPct":0,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-H6824","year":2025,"payer":"UnitedHealthcare","program":"ma","report":"H6824","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicare-Advantage-2025.pdf","readOn":"2026-10-07","stdRequests":153,"stdApproved":151,"stdDenied":2,"stdApprovedPct":98.7,"stdDeniedPct":1.3,"appeals":null,"appealApproved":0,"appealApprovedPct":0,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":18,"expApproved":18,"expDenied":0,"expApprovedPct":100,"expDeniedPct":0,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-H7464","year":2025,"payer":"UnitedHealthcare","program":"ma","report":"H7464","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicare-Advantage-2025.pdf","readOn":"2026-10-07","stdRequests":12419,"stdApproved":10943,"stdDenied":1476,"stdApprovedPct":88.1,"stdDeniedPct":11.9,"appeals":null,"appealApproved":130,"appealApprovedPct":32.3,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":873,"expApproved":540,"expDenied":333,"expApprovedPct":61.9,"expDeniedPct":38.1,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-H7833","year":2025,"payer":"UnitedHealthcare","program":"ma","report":"H7833","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicare-Advantage-2025.pdf","readOn":"2026-10-07","stdRequests":2271,"stdApproved":2255,"stdDenied":16,"stdApprovedPct":99.3,"stdDeniedPct":0.7,"appeals":null,"appealApproved":4,"appealApprovedPct":7.8,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":149,"expApproved":147,"expDenied":2,"expApprovedPct":98.7,"expDeniedPct":1.3,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-H8211","year":2025,"payer":"UnitedHealthcare","program":"ma","report":"H8211","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicare-Advantage-2025.pdf","readOn":"2026-10-07","stdRequests":12822,"stdApproved":10145,"stdDenied":2677,"stdApprovedPct":79.1,"stdDeniedPct":20.9,"appeals":null,"appealApproved":118,"appealApprovedPct":50.2,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":243,"expApproved":215,"expDenied":28,"expApprovedPct":88.5,"expDeniedPct":11.5,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-H8768","year":2025,"payer":"UnitedHealthcare","program":"ma","report":"H8768","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicare-Advantage-2025.pdf","readOn":"2026-10-07","stdRequests":310977,"stdApproved":247019,"stdDenied":63958,"stdApprovedPct":79.4,"stdDeniedPct":20.6,"appeals":null,"appealApproved":2438,"appealApprovedPct":55.8,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":13391,"expApproved":12306,"expDenied":1085,"expApprovedPct":91.9,"expDeniedPct":8.1,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-H9239","year":2025,"payer":"UnitedHealthcare","program":"ma","report":"H9239","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicare-Advantage-2025.pdf","readOn":"2026-10-07","stdRequests":6262,"stdApproved":6108,"stdDenied":154,"stdApprovedPct":97.5,"stdDeniedPct":2.5,"appeals":null,"appealApproved":27,"appealApprovedPct":19.1,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":115,"expApproved":112,"expDenied":3,"expApprovedPct":97.4,"expDeniedPct":2.6,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-R0759","year":2025,"payer":"UnitedHealthcare","program":"ma","report":"R0759","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicare-Advantage-2025.pdf","readOn":"2026-10-07","stdRequests":13563,"stdApproved":10691,"stdDenied":2872,"stdApprovedPct":78.8,"stdDeniedPct":21.2,"appeals":null,"appealApproved":158,"appealApprovedPct":62,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":1048,"expApproved":950,"expDenied":98,"expApprovedPct":90.6,"expDeniedPct":9.4,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-R2604","year":2025,"payer":"UnitedHealthcare","program":"ma","report":"R2604","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicare-Advantage-2025.pdf","readOn":"2026-10-07","stdRequests":11155,"stdApproved":8854,"stdDenied":2301,"stdApprovedPct":79.4,"stdDeniedPct":20.6,"appeals":null,"appealApproved":113,"appealApprovedPct":54.9,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":465,"expApproved":389,"expDenied":76,"expApprovedPct":83.7,"expDeniedPct":16.3,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. 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expedited 0.66 day(s) mean, 0 day(s) median","note":"Aetna posts percentages only, no counts; N/A is carried as not posted."},{"id":"aetna-H5793","year":2025,"payer":"Aetna (CVS Health)","program":"ma","report":"H5793","part":null,"url":"https://www.aetna.com/medicare/documents/individual/website/2025_PA_Metric_Report.pdf","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":94.22,"stdDeniedPct":5.78,"appeals":null,"appealApproved":null,"appealApprovedPct":86.22,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":87.12,"expDeniedPct":12.88,"stdAvgHours":27.12,"stdMedianHours":0,"expAvgHours":9.12,"expMedianHours":0,"timesAsPosted":"standard 1.13 day(s) mean, 0 day(s) median; expedited 0.38 day(s) mean, 0 day(s) median","note":"Aetna posts percentages only, no counts; N/A is carried as not posted."},{"id":"aetna-H7149","year":2025,"payer":"Aetna (CVS Health)","program":"ma","report":"H7149","part":null,"url":"https://www.aetna.com/medicare/documents/individual/website/2025_PA_Metric_Report.pdf","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":92.24,"stdDeniedPct":7.76,"appeals":null,"appealApproved":null,"appealApprovedPct":88.55,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":86.91,"expDeniedPct":13.09,"stdAvgHours":36.72,"stdMedianHours":0,"expAvgHours":9.12,"expMedianHours":0,"timesAsPosted":"standard 1.53 day(s) mean, 0 day(s) median; expedited 0.38 day(s) mean, 0 day(s) median","note":"Aetna posts percentages only, no counts; N/A is carried as not posted."},{"id":"aetna-H7301","year":2025,"payer":"Aetna (CVS Health)","program":"ma","report":"H7301","part":null,"url":"https://www.aetna.com/medicare/documents/individual/website/2025_PA_Metric_Report.pdf","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":93.98,"stdDeniedPct":6.02,"appeals":null,"appealApproved":null,"appealApprovedPct":89.77,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":88.49,"expDeniedPct":11.51,"stdAvgHours":29.04,"stdMedianHours":0,"expAvgHours":6.72,"expMedianHours":0,"timesAsPosted":"standard 1.21 day(s) mean, 0 day(s) median; expedited 0.28 day(s) mean, 0 day(s) median","note":"Aetna posts percentages only, no counts; N/A is carried as not posted."},{"id":"aetna-H8332","year":2025,"payer":"Aetna (CVS Health)","program":"ma","report":"H8332","part":null,"url":"https://www.aetna.com/medicare/documents/individual/website/2025_PA_Metric_Report.pdf","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":86.82,"stdDeniedPct":13.18,"appeals":null,"appealApproved":null,"appealApprovedPct":72.22,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":84.31,"expDeniedPct":15.69,"stdAvgHours":35.04,"stdMedianHours":0,"expAvgHours":10.32,"expMedianHours":0,"timesAsPosted":"standard 1.46 day(s) mean, 0 day(s) median; expedited 0.43 day(s) mean, 0 day(s) median","note":"Aetna posts percentages only, no counts; N/A is carried as not posted."},{"id":"aetna-H8597","year":2025,"payer":"Aetna (CVS Health)","program":"ma","report":"H8597","part":null,"url":"https://www.aetna.com/medicare/documents/individual/website/2025_PA_Metric_Report.pdf","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":87.35,"stdDeniedPct":12.65,"appeals":null,"appealApproved":null,"appealApprovedPct":86.35,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":83.74,"expDeniedPct":16.26,"stdAvgHours":42.96,"stdMedianHours":0,"expAvgHours":9.12,"expMedianHours":0,"timesAsPosted":"standard 1.79 day(s) mean, 0 day(s) median; expedited 0.38 day(s) mean, 0 day(s) median","note":"Aetna posts percentages only, no counts; N/A is carried as not posted."},{"id":"aetna-H8649","year":2025,"payer":"Aetna (CVS Health)","program":"ma","report":"H8649","part":null,"url":"https://www.aetna.com/medicare/documents/individual/website/2025_PA_Metric_Report.pdf","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":89.83,"stdDeniedPct":10.17,"appeals":null,"appealApproved":null,"appealApprovedPct":90.34,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":85.47,"expDeniedPct":14.53,"stdAvgHours":46.32,"stdMedianHours":0,"expAvgHours":11.04,"expMedianHours":0,"timesAsPosted":"standard 1.93 day(s) mean, 0 day(s) median; expedited 0.46 day(s) mean, 0 day(s) median","note":"Aetna posts percentages only, no counts; N/A is carried as not posted."},{"id":"aetna-H9431","year":2025,"payer":"Aetna (CVS Health)","program":"ma","report":"H9431","part":null,"url":"https://www.aetna.com/medicare/documents/individual/website/2025_PA_Metric_Report.pdf","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":80.14,"stdDeniedPct":19.86,"appeals":null,"appealApproved":null,"appealApprovedPct":93.75,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":85.71,"expDeniedPct":14.29,"stdAvgHours":64.08,"stdMedianHours":0,"expAvgHours":3.36,"expMedianHours":0,"timesAsPosted":"standard 2.67 day(s) mean, 0 day(s) median; expedited 0.14 day(s) mean, 0 day(s) median","note":"Aetna posts percentages only, no counts; N/A is carried as not posted."},{"id":"aetna-R6694","year":2025,"payer":"Aetna (CVS Health)","program":"ma","report":"R6694","part":null,"url":"https://www.aetna.com/medicare/documents/individual/website/2025_PA_Metric_Report.pdf","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":94.54,"stdDeniedPct":5.46,"appeals":null,"appealApproved":null,"appealApprovedPct":94.74,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":93.48,"expDeniedPct":6.52,"stdAvgHours":23.04,"stdMedianHours":0,"expAvgHours":5.28,"expMedianHours":0,"timesAsPosted":"standard 0.96 day(s) mean, 0 day(s) median; expedited 0.22 day(s) mean, 0 day(s) median","note":"Aetna posts percentages only, no counts; N/A is carried as not posted."},{"id":"uhc-medicaid-arizona-developmental-disabilities-program","year":2025,"payer":"UnitedHealthcare","program":"medicaid-mco","report":"Arizona Developmental Disabilities Program","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicaid-2025.pdf","readOn":"2026-10-07","stdRequests":10440,"stdApproved":9424,"stdDenied":1016,"stdApprovedPct":90.3,"stdDeniedPct":9.7,"appeals":null,"appealApproved":89,"appealApprovedPct":100,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":615,"expApproved":572,"expDenied":43,"expApprovedPct":93,"expDeniedPct":7,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"Filed in UnitedHealthcare's Medicaid report. UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-medicaid-arizona-ahcccs-complete-care","year":2025,"payer":"UnitedHealthcare","program":"medicaid-mco","report":"Arizona AHCCCS Complete Care","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicaid-2025.pdf","readOn":"2026-10-07","stdRequests":94879,"stdApproved":73857,"stdDenied":21022,"stdApprovedPct":77.8,"stdDeniedPct":22.2,"appeals":null,"appealApproved":216,"appealApprovedPct":90,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":11550,"expApproved":10307,"expDenied":1243,"expApprovedPct":89.2,"expDeniedPct":10.8,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"Filed in UnitedHealthcare's Medicaid report. UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-medicaid-arizona-long-term-care","year":2025,"payer":"UnitedHealthcare","program":"medicaid-mco","report":"Arizona Long Term Care","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicaid-2025.pdf","readOn":"2026-10-07","stdRequests":45798,"stdApproved":43674,"stdDenied":2124,"stdApprovedPct":95.4,"stdDeniedPct":4.6,"appeals":null,"appealApproved":37,"appealApprovedPct":97.4,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":612,"expApproved":438,"expDenied":174,"expApprovedPct":71.6,"expDeniedPct":28.4,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"Filed in UnitedHealthcare's Medicaid report. UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-medicaid-district-of-columbia-dual-choice-program","year":2025,"payer":"UnitedHealthcare","program":"medicaid-mco","report":"District of Columbia Dual Choice Program","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicaid-2025.pdf","readOn":"2026-10-07","stdRequests":23,"stdApproved":21,"stdDenied":2,"stdApprovedPct":91.3,"stdDeniedPct":8.7,"appeals":null,"appealApproved":0,"appealApprovedPct":0,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":1,"expApproved":1,"expDenied":0,"expApprovedPct":100,"expDeniedPct":0,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"Filed in UnitedHealthcare's Medicaid report. UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-medicaid-district-of-columbia-dual-choice-program-medicaid-ltss","year":2025,"payer":"UnitedHealthcare","program":"medicaid-mco","report":"District of Columbia Dual Choice Program - Medicaid LTSS","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicaid-2025.pdf","readOn":"2026-10-07","stdRequests":11877,"stdApproved":11089,"stdDenied":788,"stdApprovedPct":93.4,"stdDeniedPct":6.6,"appeals":null,"appealApproved":3,"appealApprovedPct":100,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":2,"expApproved":2,"expDenied":0,"expApprovedPct":100,"expDeniedPct":0,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"Filed in UnitedHealthcare's Medicaid report. UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-medicaid-florida-long-term-care","year":2025,"payer":"UnitedHealthcare","program":"medicaid-mco","report":"Florida Long Term Care","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicaid-2025.pdf","readOn":"2026-10-07","stdRequests":43026,"stdApproved":38931,"stdDenied":4095,"stdApprovedPct":90.5,"stdDeniedPct":9.5,"appeals":null,"appealApproved":5,"appealApprovedPct":100,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":126,"expApproved":121,"expDenied":5,"expApprovedPct":96,"expDeniedPct":4,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"Filed in UnitedHealthcare's Medicaid report. UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-medicaid-florida-managed-medical-assistance-mma","year":2025,"payer":"UnitedHealthcare","program":"medicaid-mco","report":"Florida Managed Medical Assistance (MMA)","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicaid-2025.pdf","readOn":"2026-10-07","stdRequests":70558,"stdApproved":60739,"stdDenied":9819,"stdApprovedPct":86.1,"stdDeniedPct":13.9,"appeals":null,"appealApproved":64,"appealApprovedPct":78,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":7764,"expApproved":7405,"expDenied":359,"expApprovedPct":95.4,"expDeniedPct":4.6,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"Filed in UnitedHealthcare's Medicaid report. UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-medicaid-hawaii-quest-integration","year":2025,"payer":"UnitedHealthcare","program":"medicaid-mco","report":"Hawaii Quest Integration","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicaid-2025.pdf","readOn":"2026-10-07","stdRequests":20029,"stdApproved":18757,"stdDenied":1272,"stdApprovedPct":93.6,"stdDeniedPct":6.4,"appeals":null,"appealApproved":29,"appealApprovedPct":100,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":1798,"expApproved":1721,"expDenied":77,"expApprovedPct":95.7,"expDeniedPct":4.3,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"Filed in UnitedHealthcare's Medicaid report. UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-medicaid-idaho-medicaid-plus-implus","year":2025,"payer":"UnitedHealthcare","program":"medicaid-mco","report":"Idaho Medicaid Plus (IMPlus)","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicaid-2025.pdf","readOn":"2026-10-07","stdRequests":1512,"stdApproved":1501,"stdDenied":11,"stdApprovedPct":99.3,"stdDeniedPct":0.7,"appeals":null,"appealApproved":0,"appealApprovedPct":0,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":1,"expApproved":1,"expDenied":0,"expApprovedPct":100,"expDeniedPct":0,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"Filed in UnitedHealthcare's Medicaid report. UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-medicaid-indiana-hoosier-care-connect","year":2025,"payer":"UnitedHealthcare","program":"medicaid-mco","report":"Indiana Hoosier Care Connect","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicaid-2025.pdf","readOn":"2026-10-07","stdRequests":6248,"stdApproved":5788,"stdDenied":460,"stdApprovedPct":92.6,"stdDeniedPct":7.4,"appeals":null,"appealApproved":20,"appealApprovedPct":80,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":815,"expApproved":798,"expDenied":17,"expApprovedPct":97.9,"expDeniedPct":2.1,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"Filed in UnitedHealthcare's Medicaid report. UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-medicaid-indiana-pathways-for-aging","year":2025,"payer":"UnitedHealthcare","program":"medicaid-mco","report":"Indiana PathWays for Aging","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicaid-2025.pdf","readOn":"2026-10-07","stdRequests":54990,"stdApproved":52805,"stdDenied":2185,"stdApprovedPct":96,"stdDeniedPct":4,"appeals":null,"appealApproved":37,"appealApprovedPct":100,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":339,"expApproved":299,"expDenied":40,"expApprovedPct":88.2,"expDeniedPct":11.8,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"Filed in UnitedHealthcare's Medicaid report. UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-medicaid-kansas-kancare","year":2025,"payer":"UnitedHealthcare","program":"medicaid-mco","report":"Kansas KanCare","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicaid-2025.pdf","readOn":"2026-10-07","stdRequests":94115,"stdApproved":89709,"stdDenied":4406,"stdApprovedPct":95.3,"stdDeniedPct":4.7,"appeals":null,"appealApproved":130,"appealApprovedPct":99.2,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":3587,"expApproved":3499,"expDenied":88,"expApprovedPct":97.5,"expDeniedPct":2.5,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"Filed in UnitedHealthcare's Medicaid report. UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-medicaid-kentucky-medicaid","year":2025,"payer":"UnitedHealthcare","program":"medicaid-mco","report":"Kentucky Medicaid","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicaid-2025.pdf","readOn":"2026-10-07","stdRequests":90315,"stdApproved":83102,"stdDenied":7213,"stdApprovedPct":92,"stdDeniedPct":8,"appeals":null,"appealApproved":76,"appealApprovedPct":96.2,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":8040,"expApproved":7458,"expDenied":582,"expApprovedPct":92.8,"expDeniedPct":7.2,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"Filed in UnitedHealthcare's Medicaid report. UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-medicaid-healthy-louisiana","year":2025,"payer":"UnitedHealthcare","program":"medicaid-mco","report":"Healthy Louisiana","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicaid-2025.pdf","readOn":"2026-10-07","stdRequests":136355,"stdApproved":117615,"stdDenied":18740,"stdApprovedPct":86.3,"stdDeniedPct":13.7,"appeals":null,"appealApproved":74,"appealApprovedPct":92.5,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":19807,"expApproved":17303,"expDenied":2504,"expApprovedPct":87.4,"expDeniedPct":12.6,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"Filed in UnitedHealthcare's Medicaid report. UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-medicaid-massachusetts-one-care","year":2025,"payer":"UnitedHealthcare","program":"medicaid-mco","report":"Massachusetts One Care","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicaid-2025.pdf","readOn":"2026-10-07","stdRequests":20248,"stdApproved":15708,"stdDenied":4540,"stdApprovedPct":77.6,"stdDeniedPct":22.4,"appeals":null,"appealApproved":1,"appealApprovedPct":4.2,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":54,"expApproved":49,"expDenied":5,"expApprovedPct":90.7,"expDeniedPct":9.3,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"Filed in UnitedHealthcare's Medicaid report. UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-medicaid-massachusetts-senior-care-options","year":2025,"payer":"UnitedHealthcare","program":"medicaid-mco","report":"Massachusetts Senior Care Options","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicaid-2025.pdf","readOn":"2026-10-07","stdRequests":84,"stdApproved":56,"stdDenied":28,"stdApprovedPct":66.7,"stdDeniedPct":33.3,"appeals":null,"appealApproved":0,"appealApprovedPct":0,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":null,"expDeniedPct":null,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"Filed in UnitedHealthcare's Medicaid report. No expedited requests are listed for this plan. UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-medicaid-maryland-healthchoice","year":2025,"payer":"UnitedHealthcare","program":"medicaid-mco","report":"Maryland HealthChoice","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicaid-2025.pdf","readOn":"2026-10-07","stdRequests":43808,"stdApproved":36798,"stdDenied":7010,"stdApprovedPct":84,"stdDeniedPct":16,"appeals":null,"appealApproved":59,"appealApprovedPct":81.9,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":1047,"expApproved":900,"expDenied":147,"expApprovedPct":86,"expDeniedPct":14,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"Filed in UnitedHealthcare's Medicaid report. UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-medicaid-michigan-comprehensive-health-care-program","year":2025,"payer":"UnitedHealthcare","program":"medicaid-mco","report":"Michigan Comprehensive Health Care Program","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicaid-2025.pdf","readOn":"2026-10-07","stdRequests":72585,"stdApproved":66037,"stdDenied":6548,"stdApprovedPct":91,"stdDeniedPct":9,"appeals":null,"appealApproved":192,"appealApprovedPct":99,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":6668,"expApproved":6481,"expDenied":187,"expApprovedPct":97.2,"expDeniedPct":2.8,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"Filed in UnitedHealthcare's Medicaid report. UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-medicaid-missouri-healthnet","year":2025,"payer":"UnitedHealthcare","program":"medicaid-mco","report":"Missouri HealthNet","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicaid-2025.pdf","readOn":"2026-10-07","stdRequests":68584,"stdApproved":58872,"stdDenied":9712,"stdApprovedPct":85.8,"stdDeniedPct":14.2,"appeals":null,"appealApproved":51,"appealApprovedPct":73.9,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":8752,"expApproved":8455,"expDenied":297,"expApprovedPct":96.6,"expDeniedPct":3.4,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"Filed in UnitedHealthcare's Medicaid report. UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-medicaid-mississippican","year":2025,"payer":"UnitedHealthcare","program":"medicaid-mco","report":"MississippiCAN","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicaid-2025.pdf","readOn":"2026-10-07","stdRequests":6860,"stdApproved":6466,"stdDenied":394,"stdApprovedPct":94.3,"stdDeniedPct":5.7,"appeals":null,"appealApproved":24,"appealApprovedPct":100,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":30,"expApproved":26,"expDenied":4,"expApprovedPct":86.7,"expDeniedPct":13.3,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"Filed in UnitedHealthcare's Medicaid report. UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-medicaid-mississippican-chip","year":2025,"payer":"UnitedHealthcare","program":"chip-mco","report":"MississippiCAN CHIP","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicaid-2025.pdf","readOn":"2026-10-07","stdRequests":616,"stdApproved":593,"stdDenied":23,"stdApprovedPct":96.3,"stdDeniedPct":3.7,"appeals":null,"appealApproved":1,"appealApprovedPct":100,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":34,"expApproved":33,"expDenied":1,"expApprovedPct":97.1,"expDeniedPct":2.9,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"Filed in UnitedHealthcare's Medicaid report. UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-medicaid-north-carolina-medicaid-managed-care","year":2025,"payer":"UnitedHealthcare","program":"medicaid-mco","report":"North Carolina Medicaid Managed Care","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicaid-2025.pdf","readOn":"2026-10-07","stdRequests":152752,"stdApproved":144090,"stdDenied":8662,"stdApprovedPct":94.3,"stdDeniedPct":5.7,"appeals":null,"appealApproved":88,"appealApprovedPct":64.2,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":11069,"expApproved":10286,"expDenied":783,"expApprovedPct":92.9,"expDeniedPct":7.1,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"Filed in UnitedHealthcare's Medicaid report. UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-medicaid-nebraska-heritage-health","year":2025,"payer":"UnitedHealthcare","program":"medicaid-mco","report":"Nebraska Heritage Health","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicaid-2025.pdf","readOn":"2026-10-07","stdRequests":42383,"stdApproved":38870,"stdDenied":3513,"stdApprovedPct":91.7,"stdDeniedPct":8.3,"appeals":null,"appealApproved":116,"appealApprovedPct":89.9,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":2936,"expApproved":2831,"expDenied":105,"expApprovedPct":96.4,"expDeniedPct":3.6,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"Filed in UnitedHealthcare's Medicaid report. UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-medicaid-new-jersey-familycare-medicaid","year":2025,"payer":"UnitedHealthcare","program":"medicaid-mco","report":"New Jersey FamilyCare (Medicaid)","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicaid-2025.pdf","readOn":"2026-10-07","stdRequests":279419,"stdApproved":236117,"stdDenied":43302,"stdApprovedPct":84.5,"stdDeniedPct":15.5,"appeals":null,"appealApproved":273,"appealApprovedPct":46.1,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":15491,"expApproved":14155,"expDenied":1336,"expApprovedPct":91.4,"expDeniedPct":8.6,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"Filed in UnitedHealthcare's Medicaid report. UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-medicaid-new-mexico-turquoise-care","year":2025,"payer":"UnitedHealthcare","program":"medicaid-mco","report":"New Mexico Turquoise Care","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicaid-2025.pdf","readOn":"2026-10-07","stdRequests":5838,"stdApproved":5364,"stdDenied":474,"stdApprovedPct":91.9,"stdDeniedPct":8.1,"appeals":null,"appealApproved":12,"appealApprovedPct":100,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":5,"expApproved":5,"expDenied":0,"expApprovedPct":100,"expDeniedPct":0,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"Filed in UnitedHealthcare's Medicaid report. UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-medicaid-new-york-medicaid-advantage","year":2025,"payer":"UnitedHealthcare","program":"medicaid-mco","report":"New York Medicaid Advantage","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicaid-2025.pdf","readOn":"2026-10-07","stdRequests":76049,"stdApproved":59002,"stdDenied":17047,"stdApprovedPct":77.6,"stdDeniedPct":22.4,"appeals":null,"appealApproved":94,"appealApprovedPct":100,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":1807,"expApproved":1619,"expDenied":188,"expApprovedPct":89.6,"expDeniedPct":10.4,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"Filed in UnitedHealthcare's Medicaid report. UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-medicaid-new-york-child-health-plus","year":2025,"payer":"UnitedHealthcare","program":"chip-mco","report":"New York Child Health Plus","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicaid-2025.pdf","readOn":"2026-10-07","stdRequests":1650,"stdApproved":1213,"stdDenied":437,"stdApprovedPct":73.5,"stdDeniedPct":26.5,"appeals":null,"appealApproved":1,"appealApprovedPct":100,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":30,"expApproved":29,"expDenied":1,"expApprovedPct":96.7,"expDeniedPct":3.3,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"Filed in UnitedHealthcare's Medicaid report. UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-medicaid-new-york-essential-plan-program","year":2025,"payer":"UnitedHealthcare","program":"bhp","report":"New York Essential Plan Program","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicaid-2025.pdf","readOn":"2026-10-07","stdRequests":18664,"stdApproved":15550,"stdDenied":3114,"stdApprovedPct":83.3,"stdDeniedPct":16.7,"appeals":null,"appealApproved":39,"appealApprovedPct":100,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":196,"expApproved":153,"expDenied":43,"expApprovedPct":78.1,"expDeniedPct":21.9,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"Filed in UnitedHealthcare's Medicaid report. UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-medicaid-united-healthcare-community-plan-wellness-4me","year":2025,"payer":"UnitedHealthcare","program":"medicaid-mco","report":"United Healthcare Community Plan Wellness 4Me","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicaid-2025.pdf","readOn":"2026-10-07","stdRequests":4461,"stdApproved":4060,"stdDenied":401,"stdApprovedPct":91,"stdDeniedPct":9,"appeals":null,"appealApproved":9,"appealApprovedPct":100,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":151,"expApproved":148,"expDenied":3,"expApprovedPct":98,"expDeniedPct":2,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"Filed in UnitedHealthcare's Medicaid report. UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-medicaid-ohio-mmp-program","year":2025,"payer":"UnitedHealthcare","program":"mmp","report":"Ohio MMP Program","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicaid-2025.pdf","readOn":"2026-10-07","stdRequests":18161,"stdApproved":17370,"stdDenied":791,"stdApprovedPct":95.6,"stdDeniedPct":4.4,"appeals":null,"appealApproved":7,"appealApprovedPct":100,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":35,"expApproved":34,"expDenied":1,"expApprovedPct":97.1,"expDeniedPct":2.9,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"Filed in UnitedHealthcare's Medicaid report. UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-medicaid-ohio-public-health-care-program","year":2025,"payer":"UnitedHealthcare","program":"medicaid-mco","report":"Ohio Public Health Care Program","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicaid-2025.pdf","readOn":"2026-10-07","stdRequests":113463,"stdApproved":106977,"stdDenied":6486,"stdApprovedPct":94.3,"stdDeniedPct":5.7,"appeals":null,"appealApproved":225,"appealApprovedPct":100,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":6746,"expApproved":6385,"expDenied":361,"expApprovedPct":94.6,"expDeniedPct":5.4,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"Filed in UnitedHealthcare's Medicaid report. UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-medicaid-pennsylvania-chip","year":2025,"payer":"UnitedHealthcare","program":"chip-mco","report":"Pennsylvania CHIP","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicaid-2025.pdf","readOn":"2026-10-07","stdRequests":900,"stdApproved":863,"stdDenied":37,"stdApprovedPct":95.9,"stdDeniedPct":4.1,"appeals":null,"appealApproved":1,"appealApprovedPct":50,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":null,"expDeniedPct":null,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"Filed in UnitedHealthcare's Medicaid report. No expedited requests are listed for this plan. UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-medicaid-pennsylvania-medicaid","year":2025,"payer":"UnitedHealthcare","program":"medicaid-mco","report":"Pennsylvania Medicaid","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicaid-2025.pdf","readOn":"2026-10-07","stdRequests":27830,"stdApproved":22332,"stdDenied":5498,"stdApprovedPct":80.2,"stdDeniedPct":19.8,"appeals":null,"appealApproved":51,"appealApprovedPct":63,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":1025,"expApproved":936,"expDenied":89,"expApprovedPct":91.3,"expDeniedPct":8.7,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"Filed in UnitedHealthcare's Medicaid report. UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-medicaid-rhode-island-medicaid","year":2025,"payer":"UnitedHealthcare","program":"medicaid-mco","report":"Rhode Island Medicaid","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicaid-2025.pdf","readOn":"2026-10-07","stdRequests":29701,"stdApproved":27453,"stdDenied":2248,"stdApprovedPct":92.4,"stdDeniedPct":7.6,"appeals":null,"appealApproved":46,"appealApprovedPct":95.8,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":2846,"expApproved":2747,"expDenied":99,"expApprovedPct":96.5,"expDeniedPct":3.5,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"Filed in UnitedHealthcare's Medicaid report. UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-medicaid-tennessee-tenncare","year":2025,"payer":"UnitedHealthcare","program":"medicaid-mco","report":"Tennessee TennCare","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicaid-2025.pdf","readOn":"2026-10-07","stdRequests":104271,"stdApproved":97454,"stdDenied":6817,"stdApprovedPct":93.5,"stdDeniedPct":6.5,"appeals":null,"appealApproved":215,"appealApprovedPct":100,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":6835,"expApproved":6592,"expDenied":243,"expApprovedPct":96.4,"expDeniedPct":3.6,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"Filed in UnitedHealthcare's Medicaid report. UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-medicaid-texas-chip","year":2025,"payer":"UnitedHealthcare","program":"chip-mco","report":"Texas CHIP","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicaid-2025.pdf","readOn":"2026-10-07","stdRequests":577,"stdApproved":525,"stdDenied":52,"stdApprovedPct":91,"stdDeniedPct":9,"appeals":null,"appealApproved":1,"appealApprovedPct":100,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":9,"expApproved":8,"expDenied":1,"expApprovedPct":88.9,"expDeniedPct":11.1,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"Filed in UnitedHealthcare's Medicaid report. UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-medicaid-texas-mmp","year":2025,"payer":"UnitedHealthcare","program":"mmp","report":"Texas MMP","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicaid-2025.pdf","readOn":"2026-10-07","stdRequests":240,"stdApproved":143,"stdDenied":97,"stdApprovedPct":59.6,"stdDeniedPct":40.4,"appeals":null,"appealApproved":0,"appealApprovedPct":0,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":8,"expApproved":8,"expDenied":0,"expApprovedPct":100,"expDeniedPct":0,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"Filed in UnitedHealthcare's Medicaid report. UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-medicaid-texas-star","year":2025,"payer":"UnitedHealthcare","program":"medicaid-mco","report":"Texas STAR","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicaid-2025.pdf","readOn":"2026-10-07","stdRequests":138578,"stdApproved":116384,"stdDenied":22194,"stdApprovedPct":84,"stdDeniedPct":16,"appeals":null,"appealApproved":64,"appealApprovedPct":27,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":13824,"expApproved":13128,"expDenied":696,"expApprovedPct":95,"expDeniedPct":5,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"Filed in UnitedHealthcare's Medicaid report. UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-medicaid-tx-star-kids","year":2025,"payer":"UnitedHealthcare","program":"medicaid-mco","report":"TX Star Kids","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicaid-2025.pdf","readOn":"2026-10-07","stdRequests":17856,"stdApproved":16901,"stdDenied":955,"stdApprovedPct":94.7,"stdDeniedPct":5.3,"appeals":null,"appealApproved":60,"appealApprovedPct":100,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":221,"expApproved":217,"expDenied":4,"expApprovedPct":98.2,"expDeniedPct":1.8,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"Filed in UnitedHealthcare's Medicaid report. UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-medicaid-texas-starplus","year":2025,"payer":"UnitedHealthcare","program":"medicaid-mco","report":"Texas STARPLUS","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicaid-2025.pdf","readOn":"2026-10-07","stdRequests":130178,"stdApproved":127171,"stdDenied":3007,"stdApprovedPct":97.7,"stdDeniedPct":2.3,"appeals":null,"appealApproved":82,"appealApprovedPct":100,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":818,"expApproved":794,"expDenied":24,"expApprovedPct":97.1,"expDeniedPct":2.9,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"Filed in UnitedHealthcare's Medicaid report. UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-medicaid-virginia-cardinal-care-ltss","year":2025,"payer":"UnitedHealthcare","program":"medicaid-mco","report":"Virginia Cardinal Care LTSS","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicaid-2025.pdf","readOn":"2026-10-07","stdRequests":49163,"stdApproved":43722,"stdDenied":5441,"stdApprovedPct":88.9,"stdDeniedPct":11.1,"appeals":null,"appealApproved":92,"appealApprovedPct":100,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":811,"expApproved":764,"expDenied":47,"expApprovedPct":94.2,"expDeniedPct":5.8,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"Filed in UnitedHealthcare's Medicaid report. UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-medicaid-virginia-cardinal-care-medicaid","year":2025,"payer":"UnitedHealthcare","program":"medicaid-mco","report":"Virginia Cardinal Care Medicaid","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicaid-2025.pdf","readOn":"2026-10-07","stdRequests":57435,"stdApproved":51197,"stdDenied":6238,"stdApprovedPct":89.1,"stdDeniedPct":10.9,"appeals":null,"appealApproved":5,"appealApprovedPct":45.5,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":5960,"expApproved":5455,"expDenied":505,"expApprovedPct":91.5,"expDeniedPct":8.5,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"Filed in UnitedHealthcare's Medicaid report. UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-medicaid-washington-apple-health-expansion","year":2025,"payer":"UnitedHealthcare","program":"medicaid-mco","report":"Washington Apple Health Expansion","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicaid-2025.pdf","readOn":"2026-10-07","stdRequests":20938,"stdApproved":19134,"stdDenied":1804,"stdApprovedPct":91.4,"stdDeniedPct":8.6,"appeals":null,"appealApproved":94,"appealApprovedPct":100,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":null,"expDeniedPct":null,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"Filed in UnitedHealthcare's Medicaid report. No expedited requests are listed for this plan. UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-medicaid-washington-apple-health","year":2025,"payer":"UnitedHealthcare","program":"medicaid-mco","report":"Washington Apple Health","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicaid-2025.pdf","readOn":"2026-10-07","stdRequests":36756,"stdApproved":32941,"stdDenied":3815,"stdApprovedPct":89.6,"stdDeniedPct":10.4,"appeals":null,"appealApproved":10,"appealApprovedPct":38.5,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":7117,"expApproved":6923,"expDenied":194,"expApprovedPct":97.3,"expDeniedPct":2.7,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"Filed in UnitedHealthcare's Medicaid report. UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-medicaid-wisconsin-medicaid","year":2025,"payer":"UnitedHealthcare","program":"medicaid-mco","report":"Wisconsin Medicaid","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicaid-2025.pdf","readOn":"2026-10-07","stdRequests":80913,"stdApproved":74642,"stdDenied":6271,"stdApprovedPct":92.2,"stdDeniedPct":7.8,"appeals":null,"appealApproved":183,"appealApprovedPct":98.9,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":7784,"expApproved":7525,"expDenied":259,"expApprovedPct":96.7,"expDeniedPct":3.3,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"Filed in UnitedHealthcare's Medicaid report. UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true."},{"id":"uhc-ifp-al","year":2025,"payer":"UnitedHealthcare","program":"qhp","report":"AL","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-IFP-2025.pdf","readOn":"2026-10-07","stdRequests":35528,"stdApproved":29223,"stdDenied":6305,"stdApprovedPct":82.3,"stdDeniedPct":17.7,"appeals":null,"appealApproved":51,"appealApprovedPct":44.3,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":3562,"expApproved":3268,"expDenied":294,"expApprovedPct":91.7,"expDeniedPct":8.3,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true. The posted file carries a DRAFT watermark on its last pages; the figures are carried as posted."},{"id":"uhc-ifp-az","year":2025,"payer":"UnitedHealthcare","program":"qhp","report":"AZ","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-IFP-2025.pdf","readOn":"2026-10-07","stdRequests":20358,"stdApproved":15269,"stdDenied":5089,"stdApprovedPct":75,"stdDeniedPct":25,"appeals":null,"appealApproved":16,"appealApprovedPct":29.1,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":2905,"expApproved":2691,"expDenied":214,"expApprovedPct":92.6,"expDeniedPct":7.4,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true. The posted file carries a DRAFT watermark on its last pages; the figures are carried as posted."},{"id":"uhc-ifp-fl","year":2025,"payer":"UnitedHealthcare","program":"qhp","report":"FL","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-IFP-2025.pdf","readOn":"2026-10-07","stdRequests":21218,"stdApproved":16486,"stdDenied":4732,"stdApprovedPct":77.7,"stdDeniedPct":22.3,"appeals":null,"appealApproved":23,"appealApprovedPct":41.8,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":3809,"expApproved":3553,"expDenied":256,"expApprovedPct":93.3,"expDeniedPct":6.7,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true. The posted file carries a DRAFT watermark on its last pages; the figures are carried as posted."},{"id":"uhc-ifp-ia","year":2025,"payer":"UnitedHealthcare","program":"qhp","report":"IA","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-IFP-2025.pdf","readOn":"2026-10-07","stdRequests":195,"stdApproved":171,"stdDenied":24,"stdApprovedPct":87.7,"stdDeniedPct":12.3,"appeals":null,"appealApproved":0,"appealApprovedPct":0,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":7,"expApproved":5,"expDenied":2,"expApprovedPct":71.4,"expDeniedPct":28.6,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true. The posted file carries a DRAFT watermark on its last pages; the figures are carried as posted."},{"id":"uhc-ifp-in","year":2025,"payer":"UnitedHealthcare","program":"qhp","report":"IN","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-IFP-2025.pdf","readOn":"2026-10-07","stdRequests":392,"stdApproved":311,"stdDenied":81,"stdApprovedPct":79.3,"stdDeniedPct":20.7,"appeals":null,"appealApproved":0,"appealApprovedPct":0,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":20,"expApproved":19,"expDenied":1,"expApprovedPct":95,"expDeniedPct":5,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true. The posted file carries a DRAFT watermark on its last pages; the figures are carried as posted."},{"id":"uhc-ifp-ks","year":2025,"payer":"UnitedHealthcare","program":"qhp","report":"KS","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-IFP-2025.pdf","readOn":"2026-10-07","stdRequests":6256,"stdApproved":5361,"stdDenied":895,"stdApprovedPct":85.7,"stdDeniedPct":14.3,"appeals":null,"appealApproved":13,"appealApprovedPct":61.9,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":440,"expApproved":403,"expDenied":37,"expApprovedPct":91.6,"expDeniedPct":8.4,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true. The posted file carries a DRAFT watermark on its last pages; the figures are carried as posted."},{"id":"uhc-ifp-la","year":2025,"payer":"UnitedHealthcare","program":"qhp","report":"LA","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-IFP-2025.pdf","readOn":"2026-10-07","stdRequests":6245,"stdApproved":5334,"stdDenied":911,"stdApprovedPct":85.4,"stdDeniedPct":14.6,"appeals":null,"appealApproved":10,"appealApprovedPct":45.5,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":1852,"expApproved":1780,"expDenied":72,"expApprovedPct":96.1,"expDeniedPct":3.9,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true. The posted file carries a DRAFT watermark on its last pages; the figures are carried as posted."},{"id":"uhc-ifp-mi","year":2025,"payer":"UnitedHealthcare","program":"qhp","report":"MI","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-IFP-2025.pdf","readOn":"2026-10-07","stdRequests":5301,"stdApproved":3801,"stdDenied":1500,"stdApprovedPct":71.7,"stdDeniedPct":28.3,"appeals":null,"appealApproved":8,"appealApprovedPct":40,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":717,"expApproved":673,"expDenied":44,"expApprovedPct":93.9,"expDeniedPct":6.1,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true. The posted file carries a DRAFT watermark on its last pages; the figures are carried as posted."},{"id":"uhc-ifp-mo","year":2025,"payer":"UnitedHealthcare","program":"qhp","report":"MO","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-IFP-2025.pdf","readOn":"2026-10-07","stdRequests":8639,"stdApproved":7649,"stdDenied":990,"stdApprovedPct":88.5,"stdDeniedPct":11.5,"appeals":null,"appealApproved":13,"appealApprovedPct":41.9,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":874,"expApproved":849,"expDenied":25,"expApprovedPct":97.1,"expDeniedPct":2.9,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true. The posted file carries a DRAFT watermark on its last pages; the figures are carried as posted."},{"id":"uhc-ifp-ms","year":2025,"payer":"UnitedHealthcare","program":"qhp","report":"MS","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-IFP-2025.pdf","readOn":"2026-10-07","stdRequests":2888,"stdApproved":2339,"stdDenied":549,"stdApprovedPct":81,"stdDeniedPct":19,"appeals":null,"appealApproved":3,"appealApprovedPct":42.9,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":208,"expApproved":188,"expDenied":20,"expApprovedPct":90.4,"expDeniedPct":9.6,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true. The posted file carries a DRAFT watermark on its last pages; the figures are carried as posted."},{"id":"uhc-ifp-nc","year":2025,"payer":"UnitedHealthcare","program":"qhp","report":"NC","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-IFP-2025.pdf","readOn":"2026-10-07","stdRequests":10079,"stdApproved":8866,"stdDenied":1213,"stdApprovedPct":88,"stdDeniedPct":12,"appeals":null,"appealApproved":6,"appealApprovedPct":23.1,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":1040,"expApproved":976,"expDenied":64,"expApprovedPct":93.8,"expDeniedPct":6.2,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true. The posted file carries a DRAFT watermark on its last pages; the figures are carried as posted."},{"id":"uhc-ifp-ne","year":2025,"payer":"UnitedHealthcare","program":"qhp","report":"NE","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-IFP-2025.pdf","readOn":"2026-10-07","stdRequests":825,"stdApproved":668,"stdDenied":157,"stdApprovedPct":81,"stdDeniedPct":19,"appeals":null,"appealApproved":1,"appealApprovedPct":33.3,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":64,"expApproved":58,"expDenied":6,"expApprovedPct":90.6,"expDeniedPct":9.4,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true. The posted file carries a DRAFT watermark on its last pages; the figures are carried as posted."},{"id":"uhc-ifp-oh","year":2025,"payer":"UnitedHealthcare","program":"qhp","report":"OH","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-IFP-2025.pdf","readOn":"2026-10-07","stdRequests":4636,"stdApproved":3514,"stdDenied":1122,"stdApprovedPct":75.8,"stdDeniedPct":24.2,"appeals":null,"appealApproved":5,"appealApprovedPct":38.5,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":468,"expApproved":441,"expDenied":27,"expApprovedPct":94.2,"expDeniedPct":5.8,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true. The posted file carries a DRAFT watermark on its last pages; the figures are carried as posted."},{"id":"uhc-ifp-sc","year":2025,"payer":"UnitedHealthcare","program":"qhp","report":"SC","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-IFP-2025.pdf","readOn":"2026-10-07","stdRequests":4264,"stdApproved":3194,"stdDenied":1070,"stdApprovedPct":74.9,"stdDeniedPct":25.1,"appeals":null,"appealApproved":0,"appealApprovedPct":0,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":604,"expApproved":567,"expDenied":37,"expApprovedPct":93.9,"expDeniedPct":6.1,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true. The posted file carries a DRAFT watermark on its last pages; the figures are carried as posted."},{"id":"uhc-ifp-tn","year":2025,"payer":"UnitedHealthcare","program":"qhp","report":"TN","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-IFP-2025.pdf","readOn":"2026-10-07","stdRequests":18945,"stdApproved":16765,"stdDenied":2180,"stdApprovedPct":88.5,"stdDeniedPct":11.5,"appeals":null,"appealApproved":19,"appealApprovedPct":36.5,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":2646,"expApproved":2524,"expDenied":122,"expApprovedPct":95.4,"expDeniedPct":4.6,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true. The posted file carries a DRAFT watermark on its last pages; the figures are carried as posted."},{"id":"uhc-ifp-tx","year":2025,"payer":"UnitedHealthcare","program":"qhp","report":"TX","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-IFP-2025.pdf","readOn":"2026-10-07","stdRequests":66385,"stdApproved":50743,"stdDenied":15642,"stdApprovedPct":76.4,"stdDeniedPct":23.6,"appeals":null,"appealApproved":140,"appealApprovedPct":38.6,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":13487,"expApproved":11833,"expDenied":1654,"expApprovedPct":87.7,"expDeniedPct":12.3,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true. The posted file carries a DRAFT watermark on its last pages; the figures are carried as posted."},{"id":"uhc-ifp-wi","year":2025,"payer":"UnitedHealthcare","program":"qhp","report":"WI","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-IFP-2025.pdf","readOn":"2026-10-07","stdRequests":9314,"stdApproved":8345,"stdDenied":969,"stdApprovedPct":89.6,"stdDeniedPct":10.4,"appeals":null,"appealApproved":8,"appealApprovedPct":38.1,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":640,"expApproved":571,"expDenied":69,"expApprovedPct":89.2,"expDeniedPct":10.8,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true. The posted file carries a DRAFT watermark on its last pages; the figures are carried as posted."},{"id":"uhc-ifp-wy","year":2025,"payer":"UnitedHealthcare","program":"qhp","report":"WY","part":null,"url":"https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-IFP-2025.pdf","readOn":"2026-10-07","stdRequests":996,"stdApproved":807,"stdDenied":189,"stdApprovedPct":81,"stdDeniedPct":19,"appeals":null,"appealApproved":4,"appealApprovedPct":66.7,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":72,"expApproved":60,"expDenied":12,"expApprovedPct":83.3,"expDeniedPct":16.7,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":null,"note":"UnitedHealthcare says it does not extend review timeframes, so it reports no extended-review figures. The appeal rate is posted as a percentage of total appeals without the number of appeals. Decision times are not carried: the posted mean (in whole days) is smaller than the posted median, which cannot both be true. The posted file carries a DRAFT watermark on its last pages; the figures are carried as posted."},{"id":"kaiser-co-chip-co","year":2025,"payer":"Kaiser Permanente","program":"chip-mco","report":"CO CHIP","part":null,"url":"https://healthy.kaiserpermanente.org/content/dam/kporg/legal/prior-authorization-metrics-report-co-en.pdf","readOn":"2026-10-07","stdRequests":1450,"stdApproved":1314,"stdDenied":136,"stdApprovedPct":90.62,"stdDeniedPct":9.38,"appeals":2,"appealApproved":1,"appealApprovedPct":50,"extendedRequests":0,"extendedApproved":0,"extendedApprovedPct":null,"expRequests":706,"expApproved":630,"expDenied":76,"expApprovedPct":89.24,"expDeniedPct":10.76,"stdAvgHours":62,"stdMedianHours":6,"expAvgHours":30,"expMedianHours":24,"timesAsPosted":"standard 2 Days 14 Hours mean, 0 Days 6 Hours median; expedited 1 Days 6 Hours mean, 1 Days 0 Hours median","note":"Filed in Kaiser's \"Medicaid - State level\" section, for CHIP."},{"id":"kaiser-hi-medicaid-hi","year":2025,"payer":"Kaiser Permanente","program":"medicaid-mco","report":"HI Medicaid","part":null,"url":"https://healthy.kaiserpermanente.org/content/dam/kporg/legal/prior-authorization-metrics-report-hi-en.pdf","readOn":"2026-10-07","stdRequests":10185,"stdApproved":9924,"stdDenied":261,"stdApprovedPct":97.44,"stdDeniedPct":2.56,"appeals":1,"appealApproved":0,"appealApprovedPct":0,"extendedRequests":0,"extendedApproved":0,"extendedApprovedPct":null,"expRequests":813,"expApproved":811,"expDenied":2,"expApprovedPct":99.75,"expDeniedPct":0.25,"stdAvgHours":42,"stdMedianHours":5,"expAvgHours":7,"expMedianHours":1,"timesAsPosted":"standard 1 Days 18 Hours mean, 0 Days 5 Hours median; expedited 0 Days 7 Hours mean, 0 Days 1 Hours median","note":null},{"id":"kaiser-kaiser-foundation-health-plan-inc-hios-60612-hi","year":2025,"payer":"Kaiser Permanente","program":"qhp","report":"Kaiser Foundation Health Plan, Inc. (HIOS 60612)","part":null,"url":"https://healthy.kaiserpermanente.org/content/dam/kporg/legal/prior-authorization-metrics-report-hi-en.pdf","readOn":"2026-10-07","stdRequests":2486,"stdApproved":2366,"stdDenied":120,"stdApprovedPct":95.17,"stdDeniedPct":4.83,"appeals":2,"appealApproved":2,"appealApprovedPct":100,"extendedRequests":0,"extendedApproved":0,"extendedApprovedPct":null,"expRequests":121,"expApproved":119,"expDenied":2,"expApprovedPct":98.35,"expDeniedPct":1.65,"stdAvgHours":33,"stdMedianHours":4,"expAvgHours":6,"expMedianHours":1,"timesAsPosted":"standard 1 Days 9 Hours mean, 0 Days 4 Hours median; expedited 0 Days 6 Hours mean, 0 Days 1 Hours median","note":null},{"id":"kaiser-ca-medicaid-ncal","year":2025,"payer":"Kaiser Permanente","program":"medicaid-mco","report":"CA Medicaid","part":"Northern California","url":"https://healthy.kaiserpermanente.org/content/dam/kporg/legal/prior-authorization-metrics-report-ncal-en.pdf","readOn":"2026-10-07","stdRequests":24982,"stdApproved":22747,"stdDenied":2235,"stdApprovedPct":91.05,"stdDeniedPct":8.95,"appeals":359,"appealApproved":111,"appealApprovedPct":30.92,"extendedRequests":139,"extendedApproved":71,"extendedApprovedPct":51.08,"expRequests":9581,"expApproved":8963,"expDenied":618,"expApprovedPct":93.55,"expDeniedPct":6.45,"stdAvgHours":31,"stdMedianHours":21,"expAvgHours":26,"expMedianHours":21,"timesAsPosted":"standard 1 Days 7 Hours mean, 0 Days 21 Hours median; expedited 1 Days 2 Hours mean, 0 Days 21 Hours median","note":"Kaiser reports California Medicaid in a Northern and a Southern California part; each part is its own row."},{"id":"kaiser-or-medicaid-nw","year":2025,"payer":"Kaiser Permanente","program":"medicaid-mco","report":"OR Medicaid","part":null,"url":"https://healthy.kaiserpermanente.org/content/dam/kporg/legal/prior-authorization-metrics-report-nw-en.pdf","readOn":"2026-10-07","stdRequests":12578,"stdApproved":10009,"stdDenied":2569,"stdApprovedPct":79.58,"stdDeniedPct":20.42,"appeals":185,"appealApproved":37,"appealApprovedPct":20,"extendedRequests":0,"extendedApproved":0,"extendedApprovedPct":null,"expRequests":365,"expApproved":288,"expDenied":77,"expApprovedPct":78.9,"expDeniedPct":21.1,"stdAvgHours":153,"stdMedianHours":93,"expAvgHours":25,"expMedianHours":5,"timesAsPosted":"standard 6 Days 9 Hours mean, 3 Days 21 Hours median; expedited 1 Days 1 Hours mean, 0 Days 5 Hours median","note":null},{"id":"kaiser-ca-medicaid-scal","year":2025,"payer":"Kaiser Permanente","program":"medicaid-mco","report":"CA Medicaid","part":"Southern California","url":"https://healthy.kaiserpermanente.org/content/dam/kporg/legal/prior-authorization-metrics-report-scal-en.pdf","readOn":"2026-10-07","stdRequests":56689,"stdApproved":53067,"stdDenied":3622,"stdApprovedPct":93.61,"stdDeniedPct":6.39,"appeals":234,"appealApproved":57,"appealApprovedPct":24.36,"extendedRequests":426,"extendedApproved":0,"extendedApprovedPct":0,"expRequests":7722,"expApproved":7523,"expDenied":199,"expApprovedPct":97.42,"expDeniedPct":2.58,"stdAvgHours":45,"stdMedianHours":19,"expAvgHours":4,"expMedianHours":0,"timesAsPosted":"standard 1 Days 21 Hours mean, 0 Days 19 Hours median; expedited 0 Days 4 Hours mean, 0 Days 0 Hours median","note":"Kaiser reports California Medicaid in a Northern and a Southern California part; each part is its own row."},{"id":"kaiser-md-medicaid-md-medicaid-mas","year":2025,"payer":"Kaiser Permanente","program":"medicaid-mco","report":"MD Medicaid","part":null,"url":"https://healthy.kaiserpermanente.org/content/dam/kporg/legal/prior-authorization-metrics-report-md-medicaid-mas-en.pdf","readOn":"2026-10-07","stdRequests":14541,"stdApproved":13202,"stdDenied":1028,"stdApprovedPct":90.8,"stdDeniedPct":7.1,"appeals":35,"appealApproved":11,"appealApprovedPct":31.4,"extendedRequests":0,"extendedApproved":0,"extendedApprovedPct":null,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":null,"expDeniedPct":null,"stdAvgHours":24,"stdMedianHours":13,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":"standard 1 Days 0 Hours mean, 0 Days 13 Hours median; expedited not posted mean, not posted median","note":"Standard requests only; the within-deadline figures are posted as NR (not reported). Approved and denied do not add to the requests in all (13,202 and 1,028 of 14,541), as posted."},{"id":"humana-medicaid-fl","year":2025,"payer":"Humana","program":"medicaid-mco","report":"Florida Medicaid","part":null,"url":"https://assets.humana.com/is/content/humana/Humana_FL_Prior_Auth_Metrics_PlanYear2025pdf","readOn":"2026-10-07","stdRequests":746974,"stdApproved":727877,"stdDenied":19097,"stdApprovedPct":97.44,"stdDeniedPct":2.56,"appeals":2499,"appealApproved":190,"appealApprovedPct":7.6,"extendedRequests":0,"extendedApproved":0,"extendedApprovedPct":null,"expRequests":9365,"expApproved":5538,"expDenied":3827,"expApprovedPct":59.14,"expDeniedPct":40.86,"stdAvgHours":24,"stdMedianHours":24,"expAvgHours":13,"expMedianHours":3,"timesAsPosted":"standard 1 day(s) mean, 1 day(s) median; expedited 13 hour(s) mean, 3 hour(s) median","note":"The extended-review rate is posted out of standard requests with an extended review."},{"id":"humana-medicaid-il","year":2025,"payer":"Humana","program":"medicaid-mco","report":"Illinois Medicaid","part":null,"url":"https://assets.humana.com/is/content/humana/Humana_IL_Prior_Auth_Metrics_PlanYear2025pdf","readOn":"2026-10-07","stdRequests":15116,"stdApproved":14552,"stdDenied":564,"stdApprovedPct":96.27,"stdDeniedPct":3.73,"appeals":6,"appealApproved":4,"appealApprovedPct":66.67,"extendedRequests":0,"extendedApproved":0,"extendedApprovedPct":null,"expRequests":243,"expApproved":232,"expDenied":11,"expApprovedPct":95.47,"expDeniedPct":4.53,"stdAvgHours":0,"stdMedianHours":0,"expAvgHours":5,"expMedianHours":0,"timesAsPosted":"standard 0 day(s) mean, 0 day(s) median; expedited 5 hour(s) mean, 0 hour(s) median","note":"The extended-review rate is posted out of standard requests with an extended review."},{"id":"humana-medicaid-in","year":2025,"payer":"Humana","program":"medicaid-mco","report":"Indiana Medicaid","part":null,"url":"https://assets.humana.com/is/content/humana/Humana_IN_Prior_Auth_Metrics_PlanYear2025pdf","readOn":"2026-10-07","stdRequests":26092,"stdApproved":22791,"stdDenied":3301,"stdApprovedPct":87.35,"stdDeniedPct":12.65,"appeals":991,"appealApproved":52,"appealApprovedPct":5.25,"extendedRequests":10,"extendedApproved":10,"extendedApprovedPct":100,"expRequests":1722,"expApproved":1323,"expDenied":399,"expApprovedPct":76.83,"expDeniedPct":23.17,"stdAvgHours":96,"stdMedianHours":24,"expAvgHours":47,"expMedianHours":11,"timesAsPosted":"standard 4 day(s) mean, 1 day(s) median; expedited 47 hour(s) mean, 11 hour(s) median","note":"The extended-review rate is posted out of standard requests with an extended review."},{"id":"humana-medicaid-ky","year":2025,"payer":"Humana","program":"medicaid-mco","report":"Kentucky Medicaid","part":null,"url":"https://assets.humana.com/is/content/humana/Humana_KY_Prior_Auth_Metrics_PlanYear2025pdf","readOn":"2026-10-07","stdRequests":185535,"stdApproved":161811,"stdDenied":23724,"stdApprovedPct":87.21,"stdDeniedPct":12.79,"appeals":799,"appealApproved":233,"appealApprovedPct":29.16,"extendedRequests":1,"extendedApproved":0,"extendedApprovedPct":0,"expRequests":29501,"expApproved":28872,"expDenied":629,"expApprovedPct":97.87,"expDeniedPct":2.13,"stdAvgHours":24,"stdMedianHours":24,"expAvgHours":16,"expMedianHours":7,"timesAsPosted":"standard 1 day(s) mean, 1 day(s) median; expedited 16 hour(s) mean, 7 hour(s) median","note":"The extended-review rate is posted out of standard requests with an extended review."},{"id":"humana-medicaid-la","year":2025,"payer":"Humana","program":"medicaid-mco","report":"Louisiana Medicaid","part":null,"url":"https://assets.humana.com/is/content/humana/Humana_LA_Prior_Auth_Metrics_PlanYear2025pdf","readOn":"2026-10-07","stdRequests":36389,"stdApproved":34621,"stdDenied":1768,"stdApprovedPct":95.14,"stdDeniedPct":4.86,"appeals":55,"appealApproved":17,"appealApprovedPct":30.91,"extendedRequests":1,"extendedApproved":0,"extendedApprovedPct":0,"expRequests":797,"expApproved":554,"expDenied":243,"expApprovedPct":69.51,"expDeniedPct":30.49,"stdAvgHours":48,"stdMedianHours":24,"expAvgHours":7,"expMedianHours":3,"timesAsPosted":"standard 2 day(s) mean, 1 day(s) median; expedited 7 hour(s) mean, 3 hour(s) median","note":"The extended-review rate is posted out of standard requests with an extended review."},{"id":"humana-medicaid-oh","year":2025,"payer":"Humana","program":"medicaid-mco","report":"Ohio Medicaid","part":null,"url":"https://assets.humana.com/is/content/humana/Humana_OH_Prior_Auth_Metrics_PlanYear2025pdf","readOn":"2026-10-07","stdRequests":61339,"stdApproved":52099,"stdDenied":9240,"stdApprovedPct":84.94,"stdDeniedPct":15.06,"appeals":541,"appealApproved":93,"appealApprovedPct":17.19,"extendedRequests":0,"extendedApproved":0,"extendedApprovedPct":null,"expRequests":3296,"expApproved":2692,"expDenied":604,"expApprovedPct":81.67,"expDeniedPct":18.33,"stdAvgHours":24,"stdMedianHours":24,"expAvgHours":9,"expMedianHours":2,"timesAsPosted":"standard 1 day(s) mean, 1 day(s) median; expedited 9 hour(s) mean, 2 hour(s) median","note":"The extended-review rate is posted out of standard requests with an extended review."},{"id":"humana-medicaid-ok","year":2025,"payer":"Humana","program":"medicaid-mco","report":"Oklahoma Medicaid","part":null,"url":"https://assets.humana.com/is/content/humana/Humana_OK_Prior_Auth_Metrics_PlanYear2025pdf","readOn":"2026-10-07","stdRequests":86086,"stdApproved":78740,"stdDenied":7346,"stdApprovedPct":91.47,"stdDeniedPct":8.53,"appeals":88,"appealApproved":24,"appealApprovedPct":27.27,"extendedRequests":2287,"extendedApproved":1451,"extendedApprovedPct":63.45,"expRequests":3725,"expApproved":1663,"expDenied":2062,"expApprovedPct":44.64,"expDeniedPct":55.36,"stdAvgHours":24,"stdMedianHours":24,"expAvgHours":7,"expMedianHours":4,"timesAsPosted":"standard 1 day(s) mean, 1 day(s) median; expedited 7 hour(s) mean, 4 hour(s) median","note":"The extended-review rate is posted out of standard requests with an extended review."},{"id":"humana-medicaid-sc","year":2025,"payer":"Humana","program":"medicaid-mco","report":"South Carolina Medicaid","part":null,"url":"https://assets.humana.com/is/content/humana/Humana_SC_Prior_Auth_Metrics_PlanYear2025pdf","readOn":"2026-10-07","stdRequests":14667,"stdApproved":13074,"stdDenied":1593,"stdApprovedPct":89.14,"stdDeniedPct":10.86,"appeals":48,"appealApproved":21,"appealApprovedPct":43.75,"extendedRequests":0,"extendedApproved":0,"extendedApprovedPct":null,"expRequests":3799,"expApproved":1541,"expDenied":2258,"expApprovedPct":40.56,"expDeniedPct":59.44,"stdAvgHours":72,"stdMedianHours":48,"expAvgHours":10,"expMedianHours":8,"timesAsPosted":"standard 3 day(s) mean, 2 day(s) median; expedited 10 hour(s) mean, 8 hour(s) median","note":"The extended-review rate is posted out of standard requests with an extended review."},{"id":"humana-medicaid-va","year":2025,"payer":"Humana","program":"medicaid-mco","report":"Virginia Medicaid","part":null,"url":"https://assets.humana.com/is/content/humana/Humana_VA_Prior_Auth_Metrics_PlanYear2025pdf","readOn":"2026-10-07","stdRequests":32969,"stdApproved":29118,"stdDenied":3851,"stdApprovedPct":88.32,"stdDeniedPct":11.68,"appeals":39,"appealApproved":7,"appealApprovedPct":17.95,"extendedRequests":35244,"extendedApproved":1,"extendedApprovedPct":0,"expRequests":2275,"expApproved":1462,"expDenied":813,"expApprovedPct":64.26,"expDeniedPct":35.74,"stdAvgHours":74.4,"stdMedianHours":24,"expAvgHours":20.4,"expMedianHours":4.1,"timesAsPosted":"standard 3.1 day(s) mean, 1.0 day(s) median; expedited 20.4 hour(s) mean, 4.1 hour(s) median","note":"The extended-review rate is posted out of all standard and expedited requests. The posted file is marked revised on 2026-04-01."},{"id":"oscar-13877","year":2025,"payer":"Oscar Health","program":"qhp","report":"Oscar Health Plan, Inc. - Arizona (HIOS 13877)","part":null,"url":"https://cdn.sanity.io/files/jnbz686p/hioscar_production/8f5ef95f34988b395bd86c37628759a6b6d2faa0.pdf","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":81.11,"stdDeniedPct":18.89,"appeals":null,"appealApproved":null,"appealApprovedPct":44.83,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":75.15,"expDeniedPct":24.85,"stdAvgHours":98.4,"stdMedianHours":40.8,"expAvgHours":48,"expMedianHours":48,"timesAsPosted":"standard 4.1 day(s) mean, 1.7 day(s) median; expedited 2.0 day(s) mean, 2.0 day(s) median","note":"Percentages only, no counts; denials include partial denials (\"adverse determinations\"). Oscar says it does not extend review timeframes. The file is dated 07/27/2026."},{"id":"oscar-45819","year":2025,"payer":"Oscar Health","program":"qhp","report":"Oscar Insurance Company - Iowa (HIOS 45819)","part":null,"url":"https://cdn.sanity.io/files/jnbz686p/hioscar_production/27608af3924a4e19452a9eb5b060a0c3b1c773af.pdf","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":82.38,"stdDeniedPct":17.62,"appeals":null,"appealApproved":null,"appealApprovedPct":33.87,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":57.48,"expDeniedPct":42.52,"stdAvgHours":91.2,"stdMedianHours":48,"expAvgHours":48,"expMedianHours":48,"timesAsPosted":"standard 3.8 day(s) mean, 2.0 day(s) median; expedited 2.0 day(s) mean, 2.0 day(s) median","note":"Percentages only, no counts; denials include partial denials (\"adverse determinations\"). Oscar says it does not extend review timeframes. The file is dated 07/27/2026."},{"id":"oscar-43490","year":2025,"payer":"Oscar Health","program":"qhp","report":"Oscar Insurance Company - Kansas (HIOS 43490)","part":null,"url":"https://cdn.sanity.io/files/jnbz686p/hioscar_production/122b428f547093bd789a7bc5b7bc6a517ba7dc2d.pdf","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":86.04,"stdDeniedPct":13.96,"appeals":null,"appealApproved":null,"appealApprovedPct":48.39,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":72.21,"expDeniedPct":27.79,"stdAvgHours":98.4,"stdMedianHours":45.6,"expAvgHours":24,"expMedianHours":24,"timesAsPosted":"standard 4.1 day(s) mean, 1.9 day(s) median; expedited 1.0 day(s) mean, 1.0 day(s) median","note":"Percentages only, no counts; denials include partial denials (\"adverse determinations\"). Oscar says it does not extend review timeframes. The file is dated 07/27/2026."},{"id":"oscar-77739","year":2025,"payer":"Oscar Health","program":"qhp","report":"Oscar Insurance Company - Michigan (HIOS 77739)","part":null,"url":"https://cdn.sanity.io/files/jnbz686p/hioscar_production/b1adf5d70a78e5c8239f477cb4bb19c40b68b050.pdf","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":79.55,"stdDeniedPct":20.45,"appeals":null,"appealApproved":null,"appealApprovedPct":73.33,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":75.45,"expDeniedPct":24.55,"stdAvgHours":115.2,"stdMedianHours":88.8,"expAvgHours":24,"expMedianHours":24,"timesAsPosted":"standard 4.8 day(s) mean, 3.7 day(s) median; expedited 1.0 day(s) mean, 1.0 day(s) median","note":"Percentages only, no counts; denials include partial denials (\"adverse determinations\"). Oscar says it does not extend review timeframes. The file is dated 07/27/2026."},{"id":"oscar-69512","year":2025,"payer":"Oscar Health","program":"qhp","report":"Oscar Insurance Company - Missouri (HIOS 69512)","part":null,"url":"https://cdn.sanity.io/files/jnbz686p/hioscar_production/0a97444d0027bbff62530965005a5924c37c3816.pdf","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":83.9,"stdDeniedPct":16.1,"appeals":null,"appealApproved":null,"appealApprovedPct":50,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":66.83,"expDeniedPct":33.17,"stdAvgHours":52.8,"stdMedianHours":4.8,"expAvgHours":24,"expMedianHours":24,"timesAsPosted":"standard 2.2 day(s) mean, 0.2 day(s) median; expedited 1.0 day(s) mean, 1.0 day(s) median","note":"Percentages only, no counts; denials include partial denials (\"adverse determinations\"). Oscar says it does not extend review timeframes. The file is dated 07/27/2026."},{"id":"oscar-69803","year":2025,"payer":"Oscar Health","program":"qhp","report":"Oscar Health Plan of North Carolina, Inc. (HIOS 69803)","part":null,"url":"https://cdn.sanity.io/files/jnbz686p/hioscar_production/76a66871e38fd20794887c9ba22b7f5262708129.pdf","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":82.93,"stdDeniedPct":17.07,"appeals":null,"appealApproved":null,"appealApprovedPct":43.75,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":65.28,"expDeniedPct":34.72,"stdAvgHours":50.4,"stdMedianHours":19.2,"expAvgHours":45.6,"expMedianHours":45.6,"timesAsPosted":"standard 2.1 day(s) mean, 0.8 day(s) median; expedited 1.9 day(s) mean, 1.9 day(s) median","note":"Percentages only, no counts; denials include partial denials (\"adverse determinations\"). Oscar says it does not extend review timeframes. The file is dated 07/27/2026."},{"id":"oscar-57424","year":2025,"payer":"Oscar Health","program":"qhp","report":"Oscar Insurance Company - Nebraska (HIOS 57424)","part":null,"url":"https://cdn.sanity.io/files/jnbz686p/hioscar_production/4f59f7a03c004ddf973fa8462ec7dc538e32fc85.pdf","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":83.23,"stdDeniedPct":16.77,"appeals":null,"appealApproved":null,"appealApprovedPct":50,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":62.11,"expDeniedPct":37.89,"stdAvgHours":86.4,"stdMedianHours":55.2,"expAvgHours":24,"expMedianHours":24,"timesAsPosted":"standard 3.6 day(s) mean, 2.3 day(s) median; expedited 1.0 day(s) mean, 1.0 day(s) median","note":"Percentages only, no counts; denials include partial denials (\"adverse determinations\"). Oscar says it does not extend review timeframes. The file is dated 07/27/2026."},{"id":"oscar-29341","year":2025,"payer":"Oscar Health","program":"qhp","report":"Oscar Buckeye State Insurance Corporation - Ohio (Buckeye) (HIOS 29341)","part":null,"url":"https://cdn.sanity.io/files/jnbz686p/hioscar_production/a601a2256151c4a99b39bb6af7743da4a93a3d96.pdf","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":83.38,"stdDeniedPct":16.62,"appeals":null,"appealApproved":null,"appealApprovedPct":50,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":66.48,"expDeniedPct":33.52,"stdAvgHours":38.4,"stdMedianHours":7.2,"expAvgHours":26.4,"expMedianHours":24,"timesAsPosted":"standard 1.6 day(s) mean, 0.3 day(s) median; expedited 1.1 day(s) mean, 1.0 day(s) median","note":"Percentages only, no counts; denials include partial denials (\"adverse determinations\"). Oscar says it does not extend review timeframes. The file is dated 07/27/2026."},{"id":"oscar-45845","year":2025,"payer":"Oscar Health","program":"qhp","report":"Oscar Insurance Corporation of Ohio - Cleveland (HIOS 45845)","part":null,"url":"https://cdn.sanity.io/files/jnbz686p/hioscar_production/5422810eac9776d7e1aa8773e806cb3aaeb1e282.pdf","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":81.6,"stdDeniedPct":18.4,"appeals":null,"appealApproved":null,"appealApprovedPct":63.33,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":71.19,"expDeniedPct":28.81,"stdAvgHours":57.6,"stdMedianHours":12,"expAvgHours":24,"expMedianHours":24,"timesAsPosted":"standard 2.4 day(s) mean, 0.5 day(s) median; expedited 1.0 day(s) mean, 1.0 day(s) median","note":"Percentages only, no counts; denials include partial denials (\"adverse determinations\"). Oscar says it does not extend review timeframes. The file is dated 07/27/2026."},{"id":"oscar-91908","year":2025,"payer":"Oscar Health","program":"qhp","report":"Oscar Insurance Company - Oklahoma (HIOS 91908)","part":null,"url":"https://cdn.sanity.io/files/jnbz686p/hioscar_production/d271d35069840193d9e527d1f9398805f6a4a110.pdf","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":81.54,"stdDeniedPct":18.46,"appeals":null,"appealApproved":null,"appealApprovedPct":100,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":75,"expDeniedPct":25,"stdAvgHours":69.6,"stdMedianHours":33.6,"expAvgHours":43.2,"expMedianHours":21.6,"timesAsPosted":"standard 2.9 day(s) mean, 1.4 day(s) median; expedited 1.8 day(s) mean, 0.9 day(s) median","note":"Percentages only, no counts; denials include partial denials (\"adverse determinations\"). Oscar says it does not extend review timeframes. The file is dated 07/27/2026."},{"id":"oscar-23552","year":2025,"payer":"Oscar Health","program":"qhp","report":"Oscar Insurance Company - Tennessee (HIOS 23552)","part":null,"url":"https://cdn.sanity.io/files/jnbz686p/hioscar_production/d89b38812ac53e9f612b30c05115d24568650829.pdf","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":88.11,"stdDeniedPct":11.89,"appeals":null,"appealApproved":null,"appealApprovedPct":47.41,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":73.34,"expDeniedPct":26.66,"stdAvgHours":55.2,"stdMedianHours":16.8,"expAvgHours":21.6,"expMedianHours":21.6,"timesAsPosted":"standard 2.3 day(s) mean, 0.7 day(s) median; expedited 0.9 day(s) mean, 0.9 day(s) median","note":"Percentages only, no counts; denials include partial denials (\"adverse determinations\"). Oscar says it does not extend review timeframes. The file is dated 07/27/2026."},{"id":"oscar-20069","year":2025,"payer":"Oscar Health","program":"qhp","report":"Oscar Insurance Company - Texas (HIOS 20069)","part":null,"url":"https://cdn.sanity.io/files/jnbz686p/hioscar_production/b6aa5547cf00ee28f014ef5945fe6e77b3f34f4c.pdf","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":77.29,"stdDeniedPct":22.71,"appeals":null,"appealApproved":null,"appealApprovedPct":50.55,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":69.67,"expDeniedPct":30.33,"stdAvgHours":48,"stdMedianHours":9.6,"expAvgHours":48,"expMedianHours":48,"timesAsPosted":"standard 2.0 day(s) mean, 0.4 day(s) median; expedited 2.0 day(s) mean, 2.0 day(s) median","note":"Percentages only, no counts; denials include partial denials (\"adverse determinations\"). Oscar says it does not extend review timeframes. The file is dated 07/27/2026."},{"id":"hcsc-tx","year":2025,"payer":"Health Care Service Corporation","program":"qhp","report":"Blue Cross and Blue Shield of Texas (Individual & Family)","part":null,"url":"https://www.bcbstx.com/tx/documents/individual/ifm-pa-stats-report-tx.pdf","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":94,"stdDeniedPct":6,"appeals":null,"appealApproved":null,"appealApprovedPct":14,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":90,"expDeniedPct":10,"stdAvgHours":4.8,"stdMedianHours":null,"expAvgHours":17.9,"expMedianHours":29.6,"timesAsPosted":"standard 0.2 days mean, <1 day median; urgent 17.9 hours mean, 29.6 hours median","note":"Whole percentages only, no counts; a partly approved request is counted as denied. The extended-review rate is posted as \"Not Reportable\". Urgent decision times repeat across the three HCSC states read (median 29.6 hours in all three; mean 37.3 hours in Montana and Oklahoma), so they may be company-wide figures."},{"id":"hcsc-mt","year":2025,"payer":"Health Care Service Corporation","program":"qhp","report":"Blue Cross and Blue Shield of Montana (Individual & Family)","part":null,"url":"https://www.bcbsmt.com/mt/documents/individual/ifm-pa-stats-report-mt.pdf","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":92,"stdDeniedPct":8,"appeals":null,"appealApproved":null,"appealApprovedPct":22,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":98,"expDeniedPct":2,"stdAvgHours":26.4,"stdMedianHours":null,"expAvgHours":37.3,"expMedianHours":29.6,"timesAsPosted":"standard 1.1 days mean, <1 day median; urgent 37.3 hours mean, 29.6 hours median","note":"Whole percentages only, no counts; a partly approved request is counted as denied. The extended-review rate is posted as \"Not Reportable\". Urgent decision times repeat across the three HCSC states read (median 29.6 hours in all three; mean 37.3 hours in Montana and Oklahoma), so they may be company-wide figures."},{"id":"hcsc-ok","year":2025,"payer":"Health Care Service Corporation","program":"qhp","report":"Blue Cross and Blue Shield of Oklahoma (Individual & Family)","part":null,"url":"https://www.bcbsok.com/ok/documents/individual/ifm-pa-stats-report-ok.pdf","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":92,"stdDeniedPct":8,"appeals":null,"appealApproved":null,"appealApprovedPct":31,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":81,"expDeniedPct":19,"stdAvgHours":21.6,"stdMedianHours":null,"expAvgHours":37.3,"expMedianHours":29.6,"timesAsPosted":"standard 0.9 days mean, <1 day median; urgent 37.3 hours mean, 29.6 hours median","note":"Whole percentages only, no counts; a partly approved request is counted as denied. The extended-review rate is posted as \"Not Reportable\". Urgent decision times repeat across the three HCSC states read (median 29.6 hours in all three; mean 37.3 hours in Montana and Oklahoma), so they may be company-wide figures."},{"id":"centene-qhp-al-53932","year":2025,"payer":"Centene","program":"qhp","report":"Ambetter of Alabama (HIOS 53932)","part":null,"url":"https://www.ambetterhealth.com/content/dam/centene/ambetterofalabama/pdfs/AL_MKT_ABofAL_53932_MetricsSummary_R.pdf","readOn":"2026-10-07","stdRequests":38711,"stdApproved":27669,"stdDenied":11042,"stdApprovedPct":71.48,"stdDeniedPct":28.52,"appeals":903,"appealApproved":264,"appealApprovedPct":29.24,"extendedRequests":38711,"extendedApproved":861,"extendedApprovedPct":2.22,"expRequests":1252,"expApproved":964,"expDenied":288,"expApprovedPct":77,"expDeniedPct":23,"stdAvgHours":48,"stdMedianHours":24,"expAvgHours":24,"expMedianHours":24,"timesAsPosted":"standard 2 day(s) mean, 1 day(s) median; expedited 1 day(s) mean, 1 day(s) median","note":"Times are posted in whole days; the extended-review rate is posted out of all requests."},{"id":"centene-qhp-az-91450","year":2025,"payer":"Centene","program":"qhp","report":"Ambetter from AZ Complete Health (HIOS 91450)","part":null,"url":"https://www.ambetterhealth.com/content/dam/centene/ambetteraz/pdfs/AZ_MKT_AZCompleteHealth_91450_MetricsSummary_R.pdf","readOn":"2026-10-07","stdRequests":54027,"stdApproved":39983,"stdDenied":14044,"stdApprovedPct":74.01,"stdDeniedPct":25.99,"appeals":378,"appealApproved":141,"appealApprovedPct":37.3,"extendedRequests":54027,"extendedApproved":1039,"extendedApprovedPct":1.92,"expRequests":3730,"expApproved":2834,"expDenied":896,"expApprovedPct":75.98,"expDeniedPct":24.02,"stdAvgHours":96,"stdMedianHours":24,"expAvgHours":48,"expMedianHours":24,"timesAsPosted":"standard 4 day(s) mean, 1 day(s) median; 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expedited 1 day(s) mean, 1 day(s) median","note":"Times are posted in whole days; the extended-review rate is posted out of all requests."},{"id":"centene-qhp-in-35065","year":2025,"payer":"Centene","program":"qhp","report":"Ambetter (MHS) (HIOS 35065)","part":null,"url":"https://www.ambetterhealth.com/content/dam/centene/mhsindiana/Ambetter/PDFs/IN_MKT_AH_35065_MetricsSummary_R.pdf","readOn":"2026-10-07","stdRequests":56928,"stdApproved":42933,"stdDenied":13995,"stdApprovedPct":75.42,"stdDeniedPct":24.58,"appeals":1884,"appealApproved":684,"appealApprovedPct":36.31,"extendedRequests":56928,"extendedApproved":3918,"extendedApprovedPct":6.88,"expRequests":2976,"expApproved":2224,"expDenied":752,"expApprovedPct":74.73,"expDeniedPct":25.27,"stdAvgHours":48,"stdMedianHours":24,"expAvgHours":24,"expMedianHours":0,"timesAsPosted":"standard 2 day(s) mean, 1 day(s) median; expedited 1 day(s) mean, 0 day(s) median","note":"Times are posted in whole days; the extended-review rate is posted out of all requests."},{"id":"centene-qhp-ks-34368","year":2025,"payer":"Centene","program":"qhp","report":"Ambetter from Sunflower (HIOS 34368)","part":null,"url":"https://www.ambetterhealth.com/content/dam/centene/sunflower/ambetter/pdfs/KS_MKT_ABSunflowerHealth_34368_MetricsSummary_R.pdf","readOn":"2026-10-07","stdRequests":64114,"stdApproved":47752,"stdDenied":16362,"stdApprovedPct":74.48,"stdDeniedPct":25.52,"appeals":1702,"appealApproved":891,"appealApprovedPct":52.35,"extendedRequests":64114,"extendedApproved":56,"extendedApprovedPct":0.09,"expRequests":1628,"expApproved":1344,"expDenied":284,"expApprovedPct":82.56,"expDeniedPct":17.44,"stdAvgHours":120,"stdMedianHours":48,"expAvgHours":24,"expMedianHours":0,"timesAsPosted":"standard 5 day(s) mean, 2 day(s) median; expedited 1 day(s) mean, 0 day(s) median","note":"Times are posted in whole days; the extended-review rate is posted out of all requests."},{"id":"centene-qhp-la-90787","year":2025,"payer":"Centene","program":"qhp","report":"Ambetter from Louisiana Healthcare Connections (HIOS 90787)","part":null,"url":"https://www.ambetterhealth.com/content/dam/centene/louisiana-health-connect/ambetter/pdf/LA_MKT_ABLAHealthcareConnect_90787_MetricsSummary_R.pdf","readOn":"2026-10-07","stdRequests":22862,"stdApproved":17318,"stdDenied":5544,"stdApprovedPct":75.75,"stdDeniedPct":24.25,"appeals":523,"appealApproved":160,"appealApprovedPct":30.59,"extendedRequests":22862,"extendedApproved":400,"extendedApprovedPct":1.75,"expRequests":1230,"expApproved":919,"expDenied":311,"expApprovedPct":74.72,"expDeniedPct":25.28,"stdAvgHours":72,"stdMedianHours":48,"expAvgHours":24,"expMedianHours":0,"timesAsPosted":"standard 3 day(s) mean, 2 day(s) median; expedited 1 day(s) mean, 0 day(s) median","note":"Times are posted in whole days; the extended-review rate is posted out of all requests."},{"id":"centene-qhp-mi-58594","year":2025,"payer":"Centene","program":"qhp","report":"Ambetter from Meridian (HIOS 58594)","part":null,"url":"https://www.ambetterhealth.com/content/dam/centene/ambetter-from-meridian/PDFs/MI_MKT_ABMeridian_58594_MetricsSummary_R.pdf","readOn":"2026-10-07","stdRequests":41967,"stdApproved":32463,"stdDenied":9504,"stdApprovedPct":77.35,"stdDeniedPct":22.65,"appeals":1518,"appealApproved":771,"appealApprovedPct":50.79,"extendedRequests":41967,"extendedApproved":814,"extendedApprovedPct":1.94,"expRequests":2453,"expApproved":2008,"expDenied":445,"expApprovedPct":81.86,"expDeniedPct":18.14,"stdAvgHours":72,"stdMedianHours":24,"expAvgHours":24,"expMedianHours":0,"timesAsPosted":"standard 3 day(s) mean, 1 day(s) median; expedited 1 day(s) mean, 0 day(s) median","note":"Times are posted in whole days; the extended-review rate is posted out of all requests."},{"id":"centene-qhp-mo-99723","year":2025,"payer":"Centene","program":"qhp","report":"Ambetter from Home State Health (HIOS 99723)","part":null,"url":"https://www.ambetterhealth.com/content/dam/centene/home-state-health/ambetter/pdfs/MO_MKT_ABHomeStateHealth_99723_MetricsSummary_R-1.pdf","readOn":"2026-10-07","stdRequests":89747,"stdApproved":69279,"stdDenied":20468,"stdApprovedPct":77.19,"stdDeniedPct":22.81,"appeals":2503,"appealApproved":1441,"appealApprovedPct":57.57,"extendedRequests":89747,"extendedApproved":1430,"extendedApprovedPct":1.59,"expRequests":2491,"expApproved":1923,"expDenied":568,"expApprovedPct":77.2,"expDeniedPct":22.8,"stdAvgHours":48,"stdMedianHours":0,"expAvgHours":24,"expMedianHours":0,"timesAsPosted":"standard 2 day(s) mean, 0 day(s) median; 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The extended-review rate is posted out of all requests."},{"id":"elevance-medicaid-ca","year":2025,"payer":"Elevance Health","program":"medicaid-mco","report":"Anthem Blue Cross Medi-Cal (CA)","part":null,"url":"https://mss.anthem.com/california-medicaid/ca_medicaid_priorauthsmetrics.pdf","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":97.4,"stdDeniedPct":2.6,"appeals":null,"appealApproved":null,"appealApprovedPct":34.1,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":1,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":91.9,"expDeniedPct":8.1,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":"standard 3 day mean, 1 day median; expedited 2 day mean, 1 day median (whole days; \"1 day\" means up to 24 hours)","note":"Percentages only, no counts; decision times in whole days, where 1 means up to 24 hours. The extended-review rate is posted out of all requests."},{"id":"elevance-medicaid-hcc","year":2025,"payer":"Elevance Health","program":"medicaid-mco","report":"Anthem Hoosier Care Connect (IN)","part":null,"url":"https://www.anthem.com/content/dam/digital/docs/anthem/medicaid/in/in_PAMetrics_HCC_EN.pdf","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":91,"stdDeniedPct":9,"appeals":null,"appealApproved":null,"appealApprovedPct":50.8,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":0,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":86.6,"expDeniedPct":13.4,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":"standard 1 day mean, 1 day median; expedited 1 day mean, 1 day median (whole days; \"1 day\" means up to 24 hours)","note":"Percentages only, no counts; decision times in whole days, where 1 means up to 24 hours. The extended-review rate is posted out of all requests."},{"id":"elevance-medicaid-hhw","year":2025,"payer":"Elevance Health","program":"medicaid-mco","report":"Anthem Hoosier Healthwise (IN)","part":null,"url":"https://www.anthem.com/content/dam/digital/docs/anthem/medicaid/in/in_PAMetrics_HHW_EN.pdf","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":93.2,"stdDeniedPct":6.8,"appeals":null,"appealApproved":null,"appealApprovedPct":49.4,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":0,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":85.4,"expDeniedPct":14.6,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":"standard 1 day mean, 1 day median; expedited 1 day mean, 1 day median (whole days; \"1 day\" means up to 24 hours)","note":"Percentages only, no counts; decision times in whole days, where 1 means up to 24 hours. The extended-review rate is posted out of all requests."},{"id":"elevance-medicaid-hip","year":2025,"payer":"Elevance Health","program":"medicaid-mco","report":"Anthem Healthy Indiana Plan (IN)","part":null,"url":"https://www.anthem.com/content/dam/digital/docs/anthem/medicaid/in/in_PAMetrics_HIP_EN.pdf","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":91.9,"stdDeniedPct":8.1,"appeals":null,"appealApproved":null,"appealApprovedPct":22.1,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":0,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":88,"expDeniedPct":12,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":"standard 1 day mean, 1 day median; expedited 1 day mean, 1 day median (whole days; \"1 day\" means up to 24 hours)","note":"Percentages only, no counts; decision times in whole days, where 1 means up to 24 hours. The extended-review rate is posted out of all requests."},{"id":"elevance-medicaid-pathways","year":2025,"payer":"Elevance Health","program":"medicaid-mco","report":"Anthem Indiana PathWays (IN)","part":null,"url":"https://www.anthem.com/content/dam/digital/docs/anthem/medicaid/in/in_PAMetrics_Pathways_EN.pdf","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":98.5,"stdDeniedPct":1.5,"appeals":null,"appealApproved":null,"appealApprovedPct":61.37,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":0,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":89,"expDeniedPct":11,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":"standard 7 day mean, 6 day median; expedited 1 day mean, 1 day median (whole days; \"1 day\" means up to 24 hours)","note":"Percentages only, no counts; decision times in whole days, where 1 means up to 24 hours. The extended-review rate is posted out of all requests."},{"id":"elevance-medicaid-nv","year":2025,"payer":"Elevance Health","program":"medicaid-mco","report":"Anthem Nevada Medicaid (NV)","part":null,"url":"https://www.anthem.com/content/dam/digital/docs/anthem/medicaid/nv/nv_medicaid_chip_priorauthsmetrics.pdf","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":83.6,"stdDeniedPct":16.4,"appeals":null,"appealApproved":null,"appealApprovedPct":30.4,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":0.2,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":84.9,"expDeniedPct":15.1,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":"standard 3 day mean, 1 day median; expedited 1 day mean, 1 day median (whole days; \"1 day\" means up to 24 hours)","note":"Percentages only, no counts; decision times in whole days, where 1 means up to 24 hours. The extended-review rate is posted out of all requests. This report combines Medicaid and CHIP."},{"id":"elevance-medicaid-va","year":2025,"payer":"Elevance Health","program":"medicaid-mco","report":"Anthem HealthKeepers Plus (VA)","part":null,"url":"https://www.anthem.com/content/dam/digital/docs/anthem/medicaid/va/va_medicaid_chip_priorauthsmetrics.pdf","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":88.9,"stdDeniedPct":11.1,"appeals":null,"appealApproved":null,"appealApprovedPct":28.3,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":1.9,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":93,"expDeniedPct":7,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":"standard 3 day mean, 1 day median; expedited 1 day mean, 1 day median (whole days; \"1 day\" means up to 24 hours)","note":"Percentages only, no counts; decision times in whole days, where 1 means up to 24 hours. The extended-review rate is posted out of all requests. This report combines Medicaid and CHIP."},{"id":"elevance-medicaid-ny","year":2025,"payer":"Elevance Health","program":"medicaid-mco","report":"Anthem Blue Cross and Blue Shield Medicaid (NY)","part":null,"url":"https://www.anthembluecross.com/content/dam/digital/docs/anthembluecross/medicaid/new-york/ny_medicaid_priorauthsmetrics.pdf","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":98.8,"stdDeniedPct":1.2,"appeals":null,"appealApproved":null,"appealApprovedPct":40.2,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":0,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":81.6,"expDeniedPct":18.4,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":"standard 1 day mean, 1 day median; expedited 1 day mean, 1 day median (whole days; \"1 day\" means up to 24 hours)","note":"Percentages only, no counts; decision times in whole days, where 1 means up to 24 hours. The extended-review rate is posted out of all requests."},{"id":"elevance-chip-ny-chp","year":2025,"payer":"Elevance Health","program":"chip-mco","report":"Anthem Blue Cross and Blue Shield Child Health Plus (NY)","part":null,"url":"https://www.anthembluecross.com/content/dam/digital/docs/anthembluecross/medicaid/new-york/ny_chip_priorauthsmetrics.pdf","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":88.8,"stdDeniedPct":11.6,"appeals":null,"appealApproved":null,"appealApprovedPct":42.5,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":0.7,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":90.6,"expDeniedPct":9.4,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":"standard 3 day mean, 1 day median; expedited 1 day mean, 1 day median (whole days; \"1 day\" means up to 24 hours)","note":"Percentages only, no counts; decision times in whole days, where 1 means up to 24 hours. The extended-review rate is posted out of all requests. Approved and denied add to 100.4%, as posted."},{"id":"elevance-medicaid-wi-bc","year":2025,"payer":"Elevance Health","program":"medicaid-mco","report":"Anthem BadgerCare Plus (WI)","part":null,"url":"https://mss.anthem.com/wi/wi_medicaid_badgercare_priorauthsmetrics.pdf","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":89.8,"stdDeniedPct":10.2,"appeals":null,"appealApproved":null,"appealApprovedPct":39.4,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":94.6,"expDeniedPct":5.4,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":"standard 4 day mean, 2 day median; expedited 1 day mean, 1 day median (whole days; \"1 day\" means up to 24 hours)","note":"Percentages only, no counts; decision times in whole days, where 1 means up to 24 hours. The extended-review rate is posted out of all requests."},{"id":"elevance-medicaid-wi-ssi","year":2025,"payer":"Elevance Health","program":"medicaid-mco","report":"Anthem SSI (WI)","part":null,"url":"https://mss.anthem.com/wi/wi_medicaid_ssi_priorauthsmetrics.pdf","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":72.5,"stdDeniedPct":27.5,"appeals":null,"appealApproved":null,"appealApprovedPct":41.1,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":95.3,"expDeniedPct":4.7,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":"standard 4 day mean, 4 day median; expedited 1 day mean, 1 day median (whole days; \"1 day\" means up to 24 hours)","note":"Percentages only, no counts; decision times in whole days, where 1 means up to 24 hours. The extended-review rate is posted out of all requests."},{"id":"elevance-medicaid-ga","year":2025,"payer":"Elevance Health","program":"medicaid-mco","report":"Amerigroup Community Care (GA)","part":null,"url":"https://www.myamerigroup.com/ga/ga_medicaid_chip_priorauthsmetrics.pdf","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":88,"stdDeniedPct":12,"appeals":null,"appealApproved":null,"appealApprovedPct":50.7,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":0,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":96.4,"expDeniedPct":3.6,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":"standard 2 day mean, 1 day median; expedited 1 day mean, 1 day median (whole days; \"1 day\" means up to 24 hours)","note":"Percentages only, no counts; decision times in whole days, where 1 means up to 24 hours. The extended-review rate is posted out of all requests. This report combines Medicaid and CHIP."},{"id":"elevance-medicaid-md","year":2025,"payer":"Elevance Health","program":"medicaid-mco","report":"Wellpoint Maryland (MD)","part":null,"url":"https://www.wellpoint.com/content/dam/digital/wellpoint/documents/medicaid/md-maryland/md_medicaid_chip_priorauthsmetrics.pdf","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":80,"stdDeniedPct":20,"appeals":null,"appealApproved":null,"appealApprovedPct":51.5,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":0,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":84.8,"expDeniedPct":15.2,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":"standard 1 day mean, 1 day median; expedited 1 day mean, 1 day median (whole days; \"1 day\" means up to 24 hours)","note":"Percentages only, no counts; decision times in whole days, where 1 means up to 24 hours. The extended-review rate is posted out of all requests. This report combines Medicaid and CHIP."},{"id":"elevance-medicaid-tx","year":2025,"payer":"Elevance Health","program":"medicaid-mco","report":"Wellpoint Texas (TX)","part":null,"url":"https://www.wellpoint.com/content/dam/digital/wellpoint/documents/medicaid/texas/tx_medicaid_chip_priorauthsmetrics.pdf","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":91.4,"stdDeniedPct":8.6,"appeals":null,"appealApproved":null,"appealApprovedPct":31.4,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":4.8,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":94.5,"expDeniedPct":5.5,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":"standard 1 day mean, 1 day median; expedited 1 day mean, 1 day median (whole days; \"1 day\" means up to 24 hours)","note":"Percentages only, no counts; decision times in whole days, where 1 means up to 24 hours. The extended-review rate is posted out of all requests. This report combines Medicaid and CHIP."},{"id":"elevance-medicaid-nj","year":2025,"payer":"Elevance Health","program":"medicaid-mco","report":"Wellpoint New Jersey (NJ)","part":null,"url":"https://www.wellpoint.com/content/dam/digital/wellpoint/documents/medicaid/new-jersey/nj_medicaid_chip_priorauthsmetrics.pdf","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":89.7,"stdDeniedPct":10.3,"appeals":null,"appealApproved":null,"appealApprovedPct":41.6,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":1.6,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":93,"expDeniedPct":7,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":"standard 5 day mean, 1 day median; expedited 2 day mean, 1 day median (whole days; \"1 day\" means up to 24 hours)","note":"Percentages only, no counts; decision times in whole days, where 1 means up to 24 hours. The extended-review rate is posted out of all requests. This report combines Medicaid and CHIP."},{"id":"elevance-medicaid-tn","year":2025,"payer":"Elevance Health","program":"medicaid-mco","report":"Wellpoint Tennessee (TN)","part":null,"url":"https://www.wellpoint.com/content/dam/digital/wellpoint/documents/medicaid/tennessee/tn_medicaid_chip_priorauthsmetrics.pdf","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":91.5,"stdDeniedPct":8.5,"appeals":null,"appealApproved":null,"appealApprovedPct":19.5,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":0,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":90.3,"expDeniedPct":9.7,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":"standard 3 day mean, 1 day median; expedited 1 day mean, 1 day median (whole days; \"1 day\" means up to 24 hours)","note":"Percentages only, no counts; decision times in whole days, where 1 means up to 24 hours. The extended-review rate is posted out of all requests. This report combines Medicaid and CHIP."},{"id":"elevance-medicaid-wa","year":2025,"payer":"Elevance Health","program":"medicaid-mco","report":"Wellpoint Washington (WA)","part":null,"url":"https://www.wellpoint.com/content/dam/digital/wellpoint/documents/medicaid/washington/wa_medicaid_chip_priorauthsmetrics.pdf","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":89.7,"stdDeniedPct":10.3,"appeals":null,"appealApproved":null,"appealApprovedPct":27.9,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":0,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":95.7,"expDeniedPct":4.3,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":"standard 2 day mean, 1 day median; expedited 2 day mean, 1 day median (whole days; \"1 day\" means up to 24 hours)","note":"Percentages only, no counts; decision times in whole days, where 1 means up to 24 hours. The extended-review rate is posted out of all requests."},{"id":"elevance-medicaid-dc","year":2025,"payer":"Elevance Health","program":"medicaid-mco","report":"Wellpoint District of Columbia (DC)","part":null,"url":"https://www.wellpoint.com/content/dam/digital/wellpoint/documents/medicaid/district-of-columbia/dc_medicaid_chip_priorauthsmetrics.pdf","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":91.1,"stdDeniedPct":8.9,"appeals":null,"appealApproved":null,"appealApprovedPct":61.9,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":0.3,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":80.3,"expDeniedPct":19.7,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":"standard 3 day mean, 3 day median; expedited 1 day mean, 1 day median (whole days; \"1 day\" means up to 24 hours)","note":"Percentages only, no counts; decision times in whole days, where 1 means up to 24 hours. The extended-review rate is posted out of all requests. This report combines Medicaid and CHIP."},{"id":"elevance-medicaid-ia","year":2025,"payer":"Elevance Health","program":"medicaid-mco","report":"Wellpoint Iowa (IA)","part":null,"url":"https://www.wellpoint.com/content/dam/digital/wellpoint/documents/medicaid/Iowa/ia_medicaid_chip_priorauthsmetrics.pdf","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":95.6,"stdDeniedPct":4.4,"appeals":null,"appealApproved":null,"appealApprovedPct":41.6,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":0,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":87.2,"expDeniedPct":12.8,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":"standard 2 day mean, 1 day median; expedited 1 day mean, 1 day median (whole days; \"1 day\" means up to 24 hours)","note":"Percentages only, no counts; decision times in whole days, where 1 means up to 24 hours. The extended-review rate is posted out of all requests. This report combines Medicaid and CHIP."},{"id":"elevance-medicaid-fl","year":2025,"payer":"Elevance Health","program":"medicaid-mco","report":"Simply Healthcare (FL)","part":null,"url":"https://www.simplyhealthcareplans.com/florida-medicaid/fl_medicaid_priorauthsmetrics.pdf","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":88,"stdDeniedPct":12,"appeals":null,"appealApproved":null,"appealApprovedPct":35.7,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":0.8,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":89.6,"expDeniedPct":10.4,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":"standard 1 day mean, 5 day median; expedited 1 day mean, 2 day median (whole days; \"1 day\" means up to 24 hours)","note":"Percentages only, no counts; decision times in whole days, where 1 means up to 24 hours. The extended-review rate is posted out of all requests."},{"id":"elevance-chip-fl-chip","year":2025,"payer":"Elevance Health","program":"chip-mco","report":"Simply Healthcare CHIP (FL)","part":null,"url":"https://www.simplyhealthcareplans.com/florida-medicaid/fl_chip_priorauthsmetrics.pdf","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":75.5,"stdDeniedPct":24.5,"appeals":null,"appealApproved":null,"appealApprovedPct":18.6,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":0.5,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":81,"expDeniedPct":19,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":"standard 5 day mean, 7 day median; expedited 1 day mean, 1 day median (whole days; \"1 day\" means up to 24 hours)","note":"Percentages only, no counts; decision times in whole days, where 1 means up to 24 hours. The extended-review rate is posted out of all requests."},{"id":"elevance-medicaid-la","year":2025,"payer":"Elevance Health","program":"medicaid-mco","report":"Healthy Blue Louisiana (LA)","part":null,"url":"https://www.myhealthybluela.com/la/la_medicaid_chip_priorauthsmetrics.pdf","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":93.1,"stdDeniedPct":6.9,"appeals":null,"appealApproved":null,"appealApprovedPct":22.7,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":0,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":90.1,"expDeniedPct":9.9,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":"standard 1 day mean, 1 day median; expedited 1 day mean, 1 day median (whole days; \"1 day\" means up to 24 hours)","note":"Percentages only, no counts; decision times in whole days, where 1 means up to 24 hours. The extended-review rate is posted out of all requests. This report combines Medicaid and CHIP."},{"id":"elevance-medicaid-mo","year":2025,"payer":"Elevance Health","program":"medicaid-mco","report":"Healthy Blue Missouri (MO)","part":null,"url":"https://www.healthybluemo.com/missouri-medicaid/mo_medicaid_chip_priorauthsmetrics.pdf","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":90.7,"stdDeniedPct":9.3,"appeals":null,"appealApproved":null,"appealApprovedPct":37.6,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":1.4,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":90.7,"expDeniedPct":9.3,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":"standard 1 day mean, 1 day median; expedited 1 day mean, 1 day median (whole days; \"1 day\" means up to 24 hours)","note":"Percentages only, no counts; decision times in whole days, where 1 means up to 24 hours. The extended-review rate is posted out of all requests. This report combines Medicaid and CHIP."},{"id":"elevance-medicaid-nc","year":2025,"payer":"Elevance Health","program":"medicaid-mco","report":"Healthy Blue North Carolina (NC)","part":null,"url":"https://www.healthybluenc.com/content/dam/digital/healthyblue/documents/medicaid/nc/priorauth/nc_medicaid_priorauthsmetrics.pdf","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":83.4,"stdDeniedPct":16.6,"appeals":null,"appealApproved":null,"appealApprovedPct":28.6,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":0,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":61.4,"expDeniedPct":38.6,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":"standard 3 day mean, 1 day median; expedited 1 day mean, 1 day median (whole days; \"1 day\" means up to 24 hours)","note":"Percentages only, no counts; decision times in whole days, where 1 means up to 24 hours. The extended-review rate is posted out of all requests."},{"id":"elevance-medicaid-ks","year":2025,"payer":"Elevance Health","program":"medicaid-mco","report":"Healthy Blue Kansas (KS)","part":null,"url":"https://www.healthybluekansas.com/content/dam/digital/healthyblue/documents/medicaid/ks/ks_medicaid_chip_priorauthsmetrics.pdf","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":96.6,"stdDeniedPct":3.4,"appeals":null,"appealApproved":null,"appealApprovedPct":41.6,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":0.3,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":97,"expDeniedPct":3,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":"standard 1 day mean, 1 day median; expedited 1 day mean, 1 day median (whole days; \"1 day\" means up to 24 hours)","note":"Percentages only, no counts; decision times in whole days, where 1 means up to 24 hours. The extended-review rate is posted out of all requests. This report combines Medicaid and CHIP."},{"id":"elevance-medicaid-ar","year":2025,"payer":"Elevance Health","program":"medicaid-mco","report":"Summit Community Care (PASSE) (AR)","part":null,"url":"https://www.summitcommunitycare.com/arkansas-passe/ar_medicaid_priorauthsmetrics.pdf","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":95.8,"stdDeniedPct":4.2,"appeals":null,"appealApproved":null,"appealApprovedPct":27.8,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":0,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":90.2,"expDeniedPct":9.8,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":"standard 3 day mean, 2 day median; expedited 1 day mean, 1 day median (whole days; \"1 day\" means up to 24 hours)","note":"Percentages only, no counts; decision times in whole days, where 1 means up to 24 hours. The extended-review rate is posted out of all requests."},{"id":"elevance-qhp-in","year":2025,"payer":"Elevance Health","program":"qhp","report":"Anthem (IN)","part":null,"url":"https://www.anthem.com/content/dam/digital/docs/anthem/individual-and-family/in-QHP-prior-auths-metrics.pdf","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":89.5,"stdDeniedPct":10.5,"appeals":null,"appealApproved":null,"appealApprovedPct":39,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":0.1,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":85.4,"expDeniedPct":14.6,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":"standard 1 day mean, 1 day median; expedited 1 day mean, 1 day median (whole days; \"1 day\" means up to 24 hours)","note":"Percentages only, no counts; decision times in whole days, where 1 means up to 24 hours. The extended-review rate is posted out of all requests."},{"id":"elevance-qhp-mo","year":2025,"payer":"Elevance Health","program":"qhp","report":"Anthem (MO)","part":null,"url":"https://www.anthem.com/content/dam/digital/docs/anthem/individual-and-family/mo-QHP-prior-auths-metrics.pdf","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":90.5,"stdDeniedPct":9.5,"appeals":null,"appealApproved":null,"appealApprovedPct":34,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":0.2,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":84.7,"expDeniedPct":15.3,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":"standard 1 day mean, 1 day median; expedited 2 day mean, 1 day median (whole days; \"1 day\" means up to 24 hours)","note":"Percentages only, no counts; decision times in whole days, where 1 means up to 24 hours. The extended-review rate is posted out of all requests."},{"id":"elevance-qhp-nh","year":2025,"payer":"Elevance Health","program":"qhp","report":"Anthem (NH)","part":null,"url":"https://www.anthem.com/content/dam/digital/docs/anthem/individual-and-family/nh-QHP-prior-auths-metrics.pdf","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":93.4,"stdDeniedPct":6.6,"appeals":null,"appealApproved":null,"appealApprovedPct":35,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":0.2,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":76.6,"expDeniedPct":23.4,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":"standard 2 day mean, 1 day median; expedited 3 day mean, 1 day median (whole days; \"1 day\" means up to 24 hours)","note":"Percentages only, no counts; decision times in whole days, where 1 means up to 24 hours. The extended-review rate is posted out of all requests."},{"id":"elevance-qhp-oh","year":2025,"payer":"Elevance Health","program":"qhp","report":"Anthem (OH)","part":null,"url":"https://www.anthem.com/content/dam/digital/docs/anthem/individual-and-family/oh-QHP-prior-auths-metrics.pdf","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":89.2,"stdDeniedPct":10.8,"appeals":null,"appealApproved":null,"appealApprovedPct":29,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":0.1,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":79.9,"expDeniedPct":20.1,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":"standard 2 day mean, 1 day median; expedited 2 day mean, 1 day median (whole days; \"1 day\" means up to 24 hours)","note":"Percentages only, no counts; decision times in whole days, where 1 means up to 24 hours. The extended-review rate is posted out of all requests."},{"id":"elevance-qhp-wi","year":2025,"payer":"Elevance Health","program":"qhp","report":"Anthem (WI)","part":null,"url":"https://www.anthem.com/content/dam/digital/docs/anthem/individual-and-family/wi-QHP-prior-auths-metrics.pdf","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":91.7,"stdDeniedPct":8.3,"appeals":null,"appealApproved":null,"appealApprovedPct":41,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":0.1,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":84.1,"expDeniedPct":15.9,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":"standard 3 day mean, 1 day median; expedited 3 day mean, 2 day median (whole days; \"1 day\" means up to 24 hours)","note":"Percentages only, no counts; decision times in whole days, where 1 means up to 24 hours. The extended-review rate is posted out of all requests."},{"id":"elevance-qhp-fl","year":2025,"payer":"Elevance Health","program":"qhp","report":"Wellpoint (FL)","part":null,"url":"https://www.wellpoint.com/content/dam/digital/wellpoint/documents/i-f/fl-QHP-prior-auths-metrics.pdf","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":82.1,"stdDeniedPct":17.9,"appeals":null,"appealApproved":null,"appealApprovedPct":23,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":0,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":88.9,"expDeniedPct":11.1,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":"standard 4 day mean, 1 day median; expedited 2 day mean, 1 day median (whole days; \"1 day\" means up to 24 hours)","note":"Percentages only, no counts; decision times in whole days, where 1 means up to 24 hours. The extended-review rate is posted out of all requests."},{"id":"elevance-qhp-tx","year":2025,"payer":"Elevance Health","program":"qhp","report":"Wellpoint (TX)","part":null,"url":"https://www.wellpoint.com/content/dam/digital/wellpoint/documents/i-f/tx-QHP-prior-auths-metrics.pdf","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":85.2,"stdDeniedPct":14.8,"appeals":null,"appealApproved":null,"appealApprovedPct":38,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":0,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":78.7,"expDeniedPct":21.3,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":"standard 2 day mean, 1 day median; expedited 2 day mean, 1 day median (whole days; \"1 day\" means up to 24 hours)","note":"Percentages only, no counts; decision times in whole days, where 1 means up to 24 hours. The extended-review rate is posted out of all requests."},{"id":"molina-medicaid-mco-az-mccaz-medicaid","year":2025,"payer":"Molina Healthcare","program":"medicaid-mco","report":"MCCAZ Medicaid (AZ)","part":null,"url":"https://www.molinahealthcare.com/providers/az/prior-auth","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":91,"stdDeniedPct":9,"appeals":null,"appealApproved":null,"appealApprovedPct":53,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":63,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":89,"expDeniedPct":11,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":27,"expMedianHours":21,"timesAsPosted":"standard 6 day(s) mean, 5 day(s) median (whole days); expedited 27 hour(s) mean, 21 hour(s) median","note":"Whole percentages only, no counts, posted on a web page rather than a file. Standard decision times are in whole days, so they are kept as posted and not converted to hours. Molina also posts an expedited-appeal approval rate (71%) and an expedited extended-review rate (61%), which the table has no column for."},{"id":"molina-ma-h8845-az","year":2025,"payer":"Molina Healthcare","program":"ma","report":"H8845 (AZ)","part":null,"url":"https://www.molinahealthcare.com/providers/az/prior-auth","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":95,"stdDeniedPct":5,"appeals":null,"appealApproved":null,"appealApprovedPct":100,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":100,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":85,"expDeniedPct":15,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":22,"expMedianHours":21,"timesAsPosted":"standard 2 day(s) mean, 0 day(s) median (whole days); expedited 22 hour(s) mean, 21 hour(s) median","note":"Whole percentages only, no counts, posted on a web page rather than a file. Standard decision times are in whole days, so they are kept as posted and not converted to hours. Molina also posts an expedited-appeal approval rate (not posted) and an expedited extended-review rate (not posted), which the table has no column for. Molina posts this contract on 3 state pages (AZ, MS, NM) with different figures, so each state page is its own row."},{"id":"molina-medicaid-mco-ca-california-medicaid","year":2025,"payer":"Molina Healthcare","program":"medicaid-mco","report":"California Medicaid (CA)","part":null,"url":"https://www.molinahealthcare.com/providers/ca/prior-auth","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":98,"stdDeniedPct":2,"appeals":null,"appealApproved":null,"appealApprovedPct":43,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":72,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":98,"expDeniedPct":2,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":16,"expMedianHours":3,"timesAsPosted":"standard 2 day(s) mean, 1 day(s) median (whole days); expedited 16 hour(s) mean, 3 hour(s) median","note":"Whole percentages only, no counts, posted on a web page rather than a file. Standard decision times are in whole days, so they are kept as posted and not converted to hours. Molina also posts an expedited-appeal approval rate (41%) and an expedited extended-review rate (74%), which the table has no column for."},{"id":"molina-ma-h5810-ca","year":2025,"payer":"Molina Healthcare","program":"ma","report":"H5810 (CA)","part":null,"url":"https://www.molinahealthcare.com/providers/ca/prior-auth","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":98,"stdDeniedPct":2,"appeals":null,"appealApproved":null,"appealApprovedPct":81,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":96,"expDeniedPct":4,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":15,"expMedianHours":7,"timesAsPosted":"standard 2 day(s) mean, 0 day(s) median (whole days); expedited 15 hour(s) mean, 7 hour(s) median","note":"Whole percentages only, no counts, posted on a web page rather than a file. Standard decision times are in whole days, so they are kept as posted and not converted to hours. Molina also posts an expedited-appeal approval rate (60%) and an expedited extended-review rate (not posted), which the table has no column for."},{"id":"molina-ma-h5649-ca","year":2025,"payer":"Molina Healthcare","program":"ma","report":"H5649 (CA)","part":null,"url":"https://www.molinahealthcare.com/providers/ca/prior-auth","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":99,"stdDeniedPct":1,"appeals":null,"appealApproved":null,"appealApprovedPct":50,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":95,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":99,"expDeniedPct":1,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":32,"expMedianHours":1,"timesAsPosted":"standard 2 day(s) mean, 0 day(s) median (whole days); expedited 32 hour(s) mean, 1 hour(s) median","note":"Whole percentages only, no counts, posted on a web page rather than a file. Standard decision times are in whole days, so they are kept as posted and not converted to hours. Molina also posts an expedited-appeal approval rate (57%) and an expedited extended-review rate (83%), which the table has no column for."},{"id":"molina-ma-h3038-ca","year":2025,"payer":"Molina Healthcare","program":"ma","report":"H3038 (CA)","part":null,"url":"https://www.molinahealthcare.com/providers/ca/prior-auth","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":98,"stdDeniedPct":2,"appeals":null,"appealApproved":null,"appealApprovedPct":52,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":14,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":96,"expDeniedPct":4,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":14,"expMedianHours":5,"timesAsPosted":"standard 2 day(s) mean, 0 day(s) median (whole days); expedited 14 hour(s) mean, 5 hour(s) median","note":"Whole percentages only, no counts, posted on a web page rather than a file. Standard decision times are in whole days, so they are kept as posted and not converted to hours. Molina also posts an expedited-appeal approval rate (54%) and an expedited extended-review rate (0%), which the table has no column for."},{"id":"molina-medicaid-mco-fl-florida-medicaid","year":2025,"payer":"Molina Healthcare","program":"medicaid-mco","report":"Florida Medicaid (FL)","part":null,"url":"https://www.molinahealthcare.com/providers/fl/prior-auth","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":85,"stdDeniedPct":15,"appeals":null,"appealApproved":null,"appealApprovedPct":33,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":53,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":94,"expDeniedPct":6,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":12,"expMedianHours":5,"timesAsPosted":"standard 2 day(s) mean, 1 day(s) median (whole days); expedited 12 hour(s) mean, 5 hour(s) median","note":"Whole percentages only, no counts, posted on a web page rather than a file. Standard decision times are in whole days, so they are kept as posted and not converted to hours. Molina also posts an expedited-appeal approval rate (43%) and an expedited extended-review rate (67%), which the table has no column for."},{"id":"molina-qhp","year":2025,"payer":"Molina Healthcare","program":"qhp","report":"Molina Marketplace","part":null,"url":"https://www.molinahealthcare.com/providers/oh/prior-auth","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":87,"stdDeniedPct":13,"appeals":null,"appealApproved":null,"appealApprovedPct":50,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":53,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":90,"expDeniedPct":10,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":25,"expMedianHours":23,"timesAsPosted":"standard 5 day(s) mean, 4 day(s) median (whole days); expedited 25 hour(s) mean, 23 hour(s) median","note":"Whole percentages only, no counts, posted on a web page rather than a file. Standard decision times are in whole days, so they are kept as posted and not converted to hours. Molina also posts an expedited-appeal approval rate (46%) and an expedited extended-review rate (57%), which the table has no column for. The same Marketplace figures are posted on the FL, MS, OH, SC, UT, WI pages; one row, from the Ohio page."},{"id":"molina-medicaid-mco-ia-iowa-medicaid","year":2025,"payer":"Molina Healthcare","program":"medicaid-mco","report":"Iowa Medicaid (IA)","part":null,"url":"https://www.molinahealthcare.com/providers/ia/prior-auth","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":96,"stdDeniedPct":4,"appeals":null,"appealApproved":null,"appealApprovedPct":65,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":39,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":94,"expDeniedPct":6,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":19,"expMedianHours":20,"timesAsPosted":"standard 3 day(s) mean, 2 day(s) median (whole days); expedited 19 hour(s) mean, 20 hour(s) median","note":"Whole percentages only, no counts, posted on a web page rather than a file. Standard decision times are in whole days, so they are kept as posted and not converted to hours. Molina also posts an expedited-appeal approval rate (69%) and an expedited extended-review rate (67%), which the table has no column for."},{"id":"molina-medicaid-mco-il-illinois-medicaid","year":2025,"payer":"Molina Healthcare","program":"medicaid-mco","report":"Illinois Medicaid (IL)","part":null,"url":"https://www.molinahealthcare.com/providers/il/prior-auth","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":86,"stdDeniedPct":14,"appeals":null,"appealApproved":null,"appealApprovedPct":52,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":64,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":92,"expDeniedPct":8,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":20,"expMedianHours":19,"timesAsPosted":"standard 2 day(s) mean, 1 day(s) median (whole days); expedited 20 hour(s) mean, 19 hour(s) median","note":"Whole percentages only, no counts, posted on a web page rather than a file. Standard decision times are in whole days, so they are kept as posted and not converted to hours. Molina also posts an expedited-appeal approval rate (69%) and an expedited extended-review rate (74%), which the table has no column for."},{"id":"molina-ma-h2715-il","year":2025,"payer":"Molina Healthcare","program":"ma","report":"H2715 (IL)","part":null,"url":"https://www.molinahealthcare.com/providers/il/prior-auth","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":95,"stdDeniedPct":5,"appeals":null,"appealApproved":null,"appealApprovedPct":67,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":100,"expDeniedPct":0,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":22,"expMedianHours":19,"timesAsPosted":"standard 4 day(s) mean, 3 day(s) median (whole days); expedited 22 hour(s) mean, 19 hour(s) median","note":"Whole percentages only, no counts, posted on a web page rather than a file. Standard decision times are in whole days, so they are kept as posted and not converted to hours. Molina also posts an expedited-appeal approval rate (not posted) and an expedited extended-review rate (not posted), which the table has no column for. Molina posts this contract on 2 state pages (IL, NE) with different figures, so each state page is its own row."},{"id":"molina-ma-h8046-il","year":2025,"payer":"Molina Healthcare","program":"ma","report":"H8046 (IL)","part":null,"url":"https://www.molinahealthcare.com/providers/il/prior-auth","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":90,"stdDeniedPct":10,"appeals":null,"appealApproved":null,"appealApprovedPct":49,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":33,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":85,"expDeniedPct":15,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":15,"expMedianHours":9,"timesAsPosted":"standard 1 day(s) mean, 1 day(s) median (whole days); expedited 15 hour(s) mean, 9 hour(s) median","note":"Whole percentages only, no counts, posted on a web page rather than a file. Standard decision times are in whole days, so they are kept as posted and not converted to hours. Molina also posts an expedited-appeal approval rate (51%) and an expedited extended-review rate (33%), which the table has no column for."},{"id":"molina-ma-h1799-ky","year":2025,"payer":"Molina Healthcare","program":"ma","report":"H1799 (KY)","part":null,"url":"https://www.molinahealthcare.com/providers/ky/prior-auth","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":91,"stdDeniedPct":9,"appeals":null,"appealApproved":null,"appealApprovedPct":46,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":89,"expDeniedPct":11,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":17,"expMedianHours":14,"timesAsPosted":"standard 2 day(s) mean, 1 day(s) median (whole days); expedited 17 hour(s) mean, 14 hour(s) median","note":"Whole percentages only, no counts, posted on a web page rather than a file. Standard decision times are in whole days, so they are kept as posted and not converted to hours. Molina also posts an expedited-appeal approval rate (40%) and an expedited extended-review rate (0%), which the table has no column for."},{"id":"molina-medicaid-mco-mi-michigan-medicaid","year":2025,"payer":"Molina Healthcare","program":"medicaid-mco","report":"MICHIGAN Medicaid (MI)","part":null,"url":"https://www.molinahealthcare.com/providers/mi/prior-auth","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":85,"stdDeniedPct":15,"appeals":null,"appealApproved":null,"appealApprovedPct":50,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":68,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":87,"expDeniedPct":13,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":22,"expMedianHours":22,"timesAsPosted":"standard 6 day(s) mean, 6 day(s) median (whole days); expedited 22 hour(s) mean, 22 hour(s) median","note":"Whole percentages only, no counts, posted on a web page rather than a file. Standard decision times are in whole days, so they are kept as posted and not converted to hours. Molina also posts an expedited-appeal approval rate (41%) and an expedited extended-review rate (74%), which the table has no column for."},{"id":"molina-ma-h5926-mi","year":2025,"payer":"Molina Healthcare","program":"ma","report":"H5926 (MI)","part":null,"url":"https://www.molinahealthcare.com/providers/mi/prior-auth","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":93,"stdDeniedPct":7,"appeals":null,"appealApproved":null,"appealApprovedPct":56,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":0,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":83,"expDeniedPct":17,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":20,"expMedianHours":9,"timesAsPosted":"standard 1 day(s) mean, 0 day(s) median (whole days); expedited 20 hour(s) mean, 9 hour(s) median","note":"Whole percentages only, no counts, posted on a web page rather than a file. Standard decision times are in whole days, so they are kept as posted and not converted to hours. Molina also posts an expedited-appeal approval rate (53%) and an expedited extended-review rate (0%), which the table has no column for."},{"id":"molina-ma-h7844-mi","year":2025,"payer":"Molina Healthcare","program":"ma","report":"H7844 (MI)","part":null,"url":"https://www.molinahealthcare.com/providers/mi/prior-auth","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":97,"stdDeniedPct":3,"appeals":null,"appealApproved":null,"appealApprovedPct":53,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":0,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":87,"expDeniedPct":13,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":19,"expMedianHours":19,"timesAsPosted":"standard 2 day(s) mean, 1 day(s) median (whole days); expedited 19 hour(s) mean, 19 hour(s) median","note":"Whole percentages only, no counts, posted on a web page rather than a file. Standard decision times are in whole days, so they are kept as posted and not converted to hours. Molina also posts an expedited-appeal approval rate (51%) and an expedited extended-review rate (not posted), which the table has no column for."},{"id":"molina-medicaid-mco-ms-mississippi-medicaid","year":2025,"payer":"Molina Healthcare","program":"medicaid-mco","report":"Mississippi Medicaid (MS)","part":null,"url":"https://www.molinahealthcare.com/providers/ms/prior-auth","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":93,"stdDeniedPct":7,"appeals":null,"appealApproved":null,"appealApprovedPct":58,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":54,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":93,"expDeniedPct":7,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":26,"expMedianHours":22,"timesAsPosted":"standard 2 day(s) mean, 2 day(s) median (whole days); expedited 26 hour(s) mean, 22 hour(s) median","note":"Whole percentages only, no counts, posted on a web page rather than a file. Standard decision times are in whole days, so they are kept as posted and not converted to hours. Molina also posts an expedited-appeal approval rate (41%) and an expedited extended-review rate (not posted), which the table has no column for."},{"id":"molina-ma-h8845-ms","year":2025,"payer":"Molina Healthcare","program":"ma","report":"H8845 (MS)","part":null,"url":"https://www.molinahealthcare.com/providers/ms/prior-auth","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":100,"stdDeniedPct":0,"appeals":null,"appealApproved":null,"appealApprovedPct":null,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":null,"expDeniedPct":null,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":"standard 0 day(s) mean, 0 day(s) median (whole days); expedited not posted mean, not posted median","note":"Whole percentages only, no counts, posted on a web page rather than a file. Standard decision times are in whole days, so they are kept as posted and not converted to hours. Molina also posts an expedited-appeal approval rate (not posted) and an expedited extended-review rate (not posted), which the table has no column for. Molina posts this contract on 3 state pages (AZ, MS, NM) with different figures, so each state page is its own row."},{"id":"molina-chip-mco-ne-mhne-chip-medicaid","year":2025,"payer":"Molina Healthcare","program":"chip-mco","report":"MHNE CHIP Medicaid (NE)","part":null,"url":"https://www.molinahealthcare.com/providers/ne/prior-auth","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":92,"stdDeniedPct":8,"appeals":null,"appealApproved":null,"appealApprovedPct":33,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":88,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":93,"expDeniedPct":7,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":19,"expMedianHours":20,"timesAsPosted":"standard 4 day(s) mean, 4 day(s) median (whole days); expedited 19 hour(s) mean, 20 hour(s) median","note":"Whole percentages only, no counts, posted on a web page rather than a file. Standard decision times are in whole days, so they are kept as posted and not converted to hours. Molina also posts an expedited-appeal approval rate (50%) and an expedited extended-review rate (not posted), which the table has no column for."},{"id":"molina-medicaid-mco-ne-mhne-medicaid","year":2025,"payer":"Molina Healthcare","program":"medicaid-mco","report":"MHNE MEDICAID (NE)","part":null,"url":"https://www.molinahealthcare.com/providers/ne/prior-auth","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":87,"stdDeniedPct":13,"appeals":null,"appealApproved":null,"appealApprovedPct":37,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":69,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":92,"expDeniedPct":8,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":16,"expMedianHours":17,"timesAsPosted":"standard 4 day(s) mean, 4 day(s) median (whole days); expedited 16 hour(s) mean, 17 hour(s) median","note":"Whole percentages only, no counts, posted on a web page rather than a file. Standard decision times are in whole days, so they are kept as posted and not converted to hours. Molina also posts an expedited-appeal approval rate (45%) and an expedited extended-review rate (100%), which the table has no column for."},{"id":"molina-ma-h2715-ne","year":2025,"payer":"Molina Healthcare","program":"ma","report":"H2715 (NE)","part":null,"url":"https://www.molinahealthcare.com/providers/ne/prior-auth","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":95,"stdDeniedPct":5,"appeals":null,"appealApproved":null,"appealApprovedPct":50,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":98,"expDeniedPct":2,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":22,"expMedianHours":21,"timesAsPosted":"standard 2 day(s) mean, 0 day(s) median (whole days); expedited 22 hour(s) mean, 21 hour(s) median","note":"Whole percentages only, no counts, posted on a web page rather than a file. Standard decision times are in whole days, so they are kept as posted and not converted to hours. Molina also posts an expedited-appeal approval rate (not posted) and an expedited extended-review rate (not posted), which the table has no column for. Molina posts this contract on 2 state pages (IL, NE) with different figures, so each state page is its own row."},{"id":"molina-medicaid-mco-nm-mhnm-turquoise-care-plan-medicaid","year":2025,"payer":"Molina Healthcare","program":"medicaid-mco","report":"MHNM TURQUOISE CARE PLAN Medicaid (NM)","part":null,"url":"https://www.molinahealthcare.com/providers/nm/prior-auth","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":85,"stdDeniedPct":15,"appeals":null,"appealApproved":null,"appealApprovedPct":34,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":46,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":87,"expDeniedPct":13,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":30,"expMedianHours":16,"timesAsPosted":"standard 4 day(s) mean, 2 day(s) median (whole days); expedited 30 hour(s) mean, 16 hour(s) median","note":"Whole percentages only, no counts, posted on a web page rather than a file. Standard decision times are in whole days, so they are kept as posted and not converted to hours. Molina also posts an expedited-appeal approval rate (27%) and an expedited extended-review rate (66%), which the table has no column for."},{"id":"molina-ma-h8845-nm","year":2025,"payer":"Molina Healthcare","program":"ma","report":"H8845 (NM)","part":null,"url":"https://www.molinahealthcare.com/providers/nm/prior-auth","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":92,"stdDeniedPct":8,"appeals":null,"appealApproved":null,"appealApprovedPct":33,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":89,"expDeniedPct":11,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":26,"expMedianHours":23,"timesAsPosted":"standard 3 day(s) mean, 0 day(s) median (whole days); expedited 26 hour(s) mean, 23 hour(s) median","note":"Whole percentages only, no counts, posted on a web page rather than a file. Standard decision times are in whole days, so they are kept as posted and not converted to hours. Molina also posts an expedited-appeal approval rate (not posted) and an expedited extended-review rate (not posted), which the table has no column for. Molina posts this contract on 3 state pages (AZ, MS, NM) with different figures, so each state page is its own row."},{"id":"molina-medicaid-mco-nv-nevada-medicaid","year":2025,"payer":"Molina Healthcare","program":"medicaid-mco","report":"Nevada Medicaid (NV)","part":null,"url":"https://www.molinahealthcare.com/providers/nv/prior-auth","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":82,"stdDeniedPct":18,"appeals":null,"appealApproved":null,"appealApprovedPct":70,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":59,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":87,"expDeniedPct":13,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":33,"expMedianHours":28,"timesAsPosted":"standard 7 day(s) mean, 6 day(s) median (whole days); expedited 33 hour(s) mean, 28 hour(s) median","note":"Whole percentages only, no counts, posted on a web page rather than a file. Standard decision times are in whole days, so they are kept as posted and not converted to hours. Molina also posts an expedited-appeal approval rate (69%) and an expedited extended-review rate (67%), which the table has no column for."},{"id":"molina-ma-h2478-nv","year":2025,"payer":"Molina Healthcare","program":"ma","report":"H2478 (NV)","part":null,"url":"https://www.molinahealthcare.com/providers/nv/prior-auth","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":95,"stdDeniedPct":5,"appeals":null,"appealApproved":null,"appealApprovedPct":0,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":100,"expDeniedPct":0,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":16,"expMedianHours":16,"timesAsPosted":"standard 2 day(s) mean, 0 day(s) median (whole days); expedited 16 hour(s) mean, 16 hour(s) median","note":"Whole percentages only, no counts, posted on a web page rather than a file. Standard decision times are in whole days, so they are kept as posted and not converted to hours. Molina also posts an expedited-appeal approval rate (not posted) and an expedited extended-review rate (not posted), which the table has no column for."},{"id":"molina-medicaid-mco-ny-ny-swh-medicaid-mltss","year":2025,"payer":"Molina Healthcare","program":"medicaid-mco","report":"NY SWH Medicaid MLTSS (NY)","part":null,"url":"https://www.molinahealthcare.com/providers/ny/prior-auth","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":87,"stdDeniedPct":13,"appeals":null,"appealApproved":null,"appealApprovedPct":16,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":35,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":87,"expDeniedPct":13,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":79,"expMedianHours":43,"timesAsPosted":"standard 3 day(s) mean, 1 day(s) median (whole days); expedited 79 hour(s) mean, 43 hour(s) median","note":"Whole percentages only, no counts, posted on a web page rather than a file. Standard decision times are in whole days, so they are kept as posted and not converted to hours. Molina also posts an expedited-appeal approval rate (0%) and an expedited extended-review rate (not posted), which the table has no column for."},{"id":"molina-medicaid-mco-ny-swhny-fide-medicaid","year":2025,"payer":"Molina Healthcare","program":"medicaid-mco","report":"SWHNY FIDE Medicaid (NY)","part":null,"url":"https://www.molinahealthcare.com/providers/ny/prior-auth","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":100,"stdDeniedPct":0,"appeals":null,"appealApproved":null,"appealApprovedPct":null,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":null,"expDeniedPct":null,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":"standard 5 day(s) mean, 3 day(s) median (whole days); expedited not posted mean, not posted median","note":"Whole percentages only, no counts, posted on a web page rather than a file. Standard decision times are in whole days, so they are kept as posted and not converted to hours. Molina also posts an expedited-appeal approval rate (not posted) and an expedited extended-review rate (not posted), which the table has no column for."},{"id":"molina-ma-h5992-ny","year":2025,"payer":"Molina Healthcare","program":"ma","report":"H5992 (NY)","part":null,"url":"https://www.molinahealthcare.com/providers/ny/prior-auth","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":92,"stdDeniedPct":8,"appeals":null,"appealApproved":null,"appealApprovedPct":30,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":38,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":88,"expDeniedPct":12,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":18,"expMedianHours":17,"timesAsPosted":"standard 2 day(s) mean, 1 day(s) median (whole days); expedited 18 hour(s) mean, 17 hour(s) median","note":"Whole percentages only, no counts, posted on a web page rather than a file. Standard decision times are in whole days, so they are kept as posted and not converted to hours. Molina also posts an expedited-appeal approval rate (100%) and an expedited extended-review rate (0%), which the table has no column for."},{"id":"molina-ma-h5280-oh","year":2025,"payer":"Molina Healthcare","program":"ma","report":"H5280 (OH)","part":null,"url":"https://www.molinahealthcare.com/providers/oh/prior-auth","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":91,"stdDeniedPct":9,"appeals":null,"appealApproved":null,"appealApprovedPct":40,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":88,"expDeniedPct":12,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":12,"expMedianHours":6,"timesAsPosted":"standard 3 day(s) mean, 1 day(s) median (whole days); expedited 12 hour(s) mean, 6 hour(s) median","note":"Whole percentages only, no counts, posted on a web page rather than a file. Standard decision times are in whole days, so they are kept as posted and not converted to hours. Molina also posts an expedited-appeal approval rate (38%) and an expedited extended-review rate (not posted), which the table has no column for."},{"id":"molina-ma-h9955-oh","year":2025,"payer":"Molina Healthcare","program":"ma","report":"H9955 (OH)","part":null,"url":"https://www.molinahealthcare.com/providers/oh/prior-auth","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":93,"stdDeniedPct":7,"appeals":null,"appealApproved":null,"appealApprovedPct":53,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":90,"expDeniedPct":10,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":18,"expMedianHours":17,"timesAsPosted":"standard 2 day(s) mean, 0 day(s) median (whole days); expedited 18 hour(s) mean, 17 hour(s) median","note":"Whole percentages only, no counts, posted on a web page rather than a file. Standard decision times are in whole days, so they are kept as posted and not converted to hours. Molina also posts an expedited-appeal approval rate (55%) and an expedited extended-review rate (not posted), which the table has no column for."},{"id":"molina-medicaid-mco-sc-south-carolina-medicaid","year":2025,"payer":"Molina Healthcare","program":"medicaid-mco","report":"South Carolina Medicaid (SC)","part":null,"url":"https://www.molinahealthcare.com/providers/sc/prior-auth","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":73,"stdDeniedPct":27,"appeals":null,"appealApproved":null,"appealApprovedPct":18,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":58,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":89,"expDeniedPct":11,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":21,"expMedianHours":20,"timesAsPosted":"standard 8 day(s) mean, 9 day(s) median (whole days); expedited 21 hour(s) mean, 20 hour(s) median","note":"Whole percentages only, no counts, posted on a web page rather than a file. Standard decision times are in whole days, so they are kept as posted and not converted to hours. Molina also posts an expedited-appeal approval rate (16%) and an expedited extended-review rate (50%), which the table has no column for."},{"id":"molina-ma-h2533-sc","year":2025,"payer":"Molina Healthcare","program":"ma","report":"H2533 (SC)","part":null,"url":"https://www.molinahealthcare.com/providers/sc/prior-auth","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":91,"stdDeniedPct":9,"appeals":null,"appealApproved":null,"appealApprovedPct":56,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":0,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":95,"expDeniedPct":5,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":17,"expMedianHours":18,"timesAsPosted":"standard 3 day(s) mean, 2 day(s) median (whole days); expedited 17 hour(s) mean, 18 hour(s) median","note":"Whole percentages only, no counts, posted on a web page rather than a file. Standard decision times are in whole days, so they are kept as posted and not converted to hours. Molina also posts an expedited-appeal approval rate (77%) and an expedited extended-review rate (100%), which the table has no column for."},{"id":"molina-ma-h8176-sc","year":2025,"payer":"Molina Healthcare","program":"ma","report":"H8176 (SC)","part":null,"url":"https://www.molinahealthcare.com/providers/sc/prior-auth","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":94,"stdDeniedPct":6,"appeals":null,"appealApproved":null,"appealApprovedPct":75,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":88,"expDeniedPct":13,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":13,"expMedianHours":7,"timesAsPosted":"standard 2 day(s) mean, 1 day(s) median (whole days); expedited 13 hour(s) mean, 7 hour(s) median","note":"Whole percentages only, no counts, posted on a web page rather than a file. Standard decision times are in whole days, so they are kept as posted and not converted to hours. Molina also posts an expedited-appeal approval rate (100%) and an expedited extended-review rate (not posted), which the table has no column for."},{"id":"molina-medicaid-mco-ut-utah-integrated-care-plan-non-traditional-medicaid","year":2025,"payer":"Molina Healthcare","program":"medicaid-mco","report":"UTAH INTEGRATED CARE PLAN - NON-TRADITIONAL Medicaid (UT)","part":null,"url":"https://www.molinahealthcare.com/providers/ut/prior-auth","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":100,"stdDeniedPct":0,"appeals":null,"appealApproved":null,"appealApprovedPct":null,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":100,"expDeniedPct":0,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":2,"expMedianHours":2,"timesAsPosted":"standard 10 day(s) mean, 9 day(s) median (whole days); expedited 2 hour(s) mean, 2 hour(s) median","note":"Whole percentages only, no counts, posted on a web page rather than a file. Standard decision times are in whole days, so they are kept as posted and not converted to hours. Molina also posts an expedited-appeal approval rate (not posted) and an expedited extended-review rate (not posted), which the table has no column for."},{"id":"molina-chip-mco-ut-utah-healthy-kids-plan-b-medicaid","year":2025,"payer":"Molina Healthcare","program":"chip-mco","report":"UTAH HEALTHY KIDS PLAN B Medicaid (UT)","part":null,"url":"https://www.molinahealthcare.com/providers/ut/prior-auth","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":82,"stdDeniedPct":18,"appeals":null,"appealApproved":null,"appealApprovedPct":67,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":100,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":100,"expDeniedPct":0,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":27,"expMedianHours":19,"timesAsPosted":"standard 6 day(s) mean, 6 day(s) median (whole days); expedited 27 hour(s) mean, 19 hour(s) median","note":"Whole percentages only, no counts, posted on a web page rather than a file. Standard decision times are in whole days, so they are kept as posted and not converted to hours. Molina also posts an expedited-appeal approval rate (not posted) and an expedited extended-review rate (not posted), which the table has no column for. Utah's Healthy Kids plan is the state's CHIP."},{"id":"molina-medicaid-mco-ut-utah-integrated-care-plan-traditional-medicaid","year":2025,"payer":"Molina Healthcare","program":"medicaid-mco","report":"UTAH INTEGRATED CARE PLAN - TRADITIONAL Medicaid (UT)","part":null,"url":"https://www.molinahealthcare.com/providers/ut/prior-auth","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":81,"stdDeniedPct":19,"appeals":null,"appealApproved":null,"appealApprovedPct":68,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":64,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":88,"expDeniedPct":12,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":21,"expMedianHours":20,"timesAsPosted":"standard 6 day(s) mean, 6 day(s) median (whole days); expedited 21 hour(s) mean, 20 hour(s) median","note":"Whole percentages only, no counts, posted on a web page rather than a file. Standard decision times are in whole days, so they are kept as posted and not converted to hours. Molina also posts an expedited-appeal approval rate (58%) and an expedited extended-review rate (50%), which the table has no column for."},{"id":"molina-medicaid-mco-ut-utah-urban-medicaid-traditional-no-copay-no-coins","year":2025,"payer":"Molina Healthcare","program":"medicaid-mco","report":"UTAH URBAN MEDICAID TRADITIONAL - NO COPAY - NO COINS (UT)","part":null,"url":"https://www.molinahealthcare.com/providers/ut/prior-auth","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":76,"stdDeniedPct":24,"appeals":null,"appealApproved":null,"appealApprovedPct":77,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":54,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":90,"expDeniedPct":10,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":21,"expMedianHours":20,"timesAsPosted":"standard 7 day(s) mean, 6 day(s) median (whole days); expedited 21 hour(s) mean, 20 hour(s) median","note":"Whole percentages only, no counts, posted on a web page rather than a file. Standard decision times are in whole days, so they are kept as posted and not converted to hours. Molina also posts an expedited-appeal approval rate (76%) and an expedited extended-review rate (100%), which the table has no column for."},{"id":"molina-medicaid-mco-ut-utah-urban-medicaid-traditional-w-copay-no-coins","year":2025,"payer":"Molina Healthcare","program":"medicaid-mco","report":"UTAH URBAN MEDICAID TRADITIONAL - W/ COPAY - NO COINS (UT)","part":null,"url":"https://www.molinahealthcare.com/providers/ut/prior-auth","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":80,"stdDeniedPct":20,"appeals":null,"appealApproved":null,"appealApprovedPct":83,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":100,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":89,"expDeniedPct":11,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":18,"expMedianHours":19,"timesAsPosted":"standard 6 day(s) mean, 6 day(s) median (whole days); expedited 18 hour(s) mean, 19 hour(s) median","note":"Whole percentages only, no counts, posted on a web page rather than a file. Standard decision times are in whole days, so they are kept as posted and not converted to hours. Molina also posts an expedited-appeal approval rate (0%) and an expedited extended-review rate (not posted), which the table has no column for."},{"id":"molina-chip-mco-ut-utah-healthy-kids-plan-c-medicaid","year":2025,"payer":"Molina Healthcare","program":"chip-mco","report":"UTAH HEALTHY KIDS PLAN C Medicaid (UT)","part":null,"url":"https://www.molinahealthcare.com/providers/ut/prior-auth","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":72,"stdDeniedPct":28,"appeals":null,"appealApproved":null,"appealApprovedPct":93,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":100,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":94,"expDeniedPct":6,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":19,"expMedianHours":20,"timesAsPosted":"standard 7 day(s) mean, 7 day(s) median (whole days); expedited 19 hour(s) mean, 20 hour(s) median","note":"Whole percentages only, no counts, posted on a web page rather than a file. Standard decision times are in whole days, so they are kept as posted and not converted to hours. Molina also posts an expedited-appeal approval rate (not posted) and an expedited extended-review rate (not posted), which the table has no column for. Utah's Healthy Kids plan is the state's CHIP."},{"id":"molina-medicaid-mco-ut-z-utah-urban-medicaid-non-traditional-no-copay-no-coins","year":2025,"payer":"Molina Healthcare","program":"medicaid-mco","report":"Z UTAH URBAN MEDICAID NON-TRADITIONAL - NO COPAY - NO COINS (UT)","part":null,"url":"https://www.molinahealthcare.com/providers/ut/prior-auth","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":50,"stdDeniedPct":50,"appeals":null,"appealApproved":null,"appealApprovedPct":null,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":null,"expDeniedPct":null,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":"standard 9 day(s) mean, 7 day(s) median (whole days); expedited not posted mean, not posted median","note":"Whole percentages only, no counts, posted on a web page rather than a file. Standard decision times are in whole days, so they are kept as posted and not converted to hours. Molina also posts an expedited-appeal approval rate (not posted) and an expedited extended-review rate (not posted), which the table has no column for."},{"id":"molina-chip-mco-ut-utah-healthy-kids-plan-c-n-medicaid","year":2025,"payer":"Molina Healthcare","program":"chip-mco","report":"UTAH HEALTHY KIDS PLAN C - N Medicaid (UT)","part":null,"url":"https://www.molinahealthcare.com/providers/ut/prior-auth","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":75,"stdDeniedPct":25,"appeals":null,"appealApproved":null,"appealApprovedPct":null,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":null,"expDeniedPct":null,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":"standard 4 day(s) mean, 3 day(s) median (whole days); expedited not posted mean, not posted median","note":"Whole percentages only, no counts, posted on a web page rather than a file. Standard decision times are in whole days, so they are kept as posted and not converted to hours. Molina also posts an expedited-appeal approval rate (not posted) and an expedited extended-review rate (not posted), which the table has no column for. Utah's Healthy Kids plan is the state's CHIP."},{"id":"molina-ma-h5628-ut","year":2025,"payer":"Molina Healthcare","program":"ma","report":"H5628 (UT)","part":null,"url":"https://www.molinahealthcare.com/providers/ut/prior-auth","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":91,"stdDeniedPct":9,"appeals":null,"appealApproved":null,"appealApprovedPct":69,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":100,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":92,"expDeniedPct":8,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":21,"expMedianHours":19,"timesAsPosted":"standard 3 day(s) mean, 1 day(s) median (whole days); expedited 21 hour(s) mean, 19 hour(s) median","note":"Whole percentages only, no counts, posted on a web page rather than a file. Standard decision times are in whole days, so they are kept as posted and not converted to hours. Molina also posts an expedited-appeal approval rate (73%) and an expedited extended-review rate (100%), which the table has no column for."},{"id":"molina-medicaid-mco-wa-washington-medicaid","year":2025,"payer":"Molina Healthcare","program":"medicaid-mco","report":"Washington Medicaid (WA)","part":null,"url":"https://www.molinahealthcare.com/providers/wa/prior-auth","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":84,"stdDeniedPct":16,"appeals":null,"appealApproved":null,"appealApprovedPct":54,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":66,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":83,"expDeniedPct":17,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":16,"expMedianHours":11,"timesAsPosted":"standard 2 day(s) mean, 1 day(s) median (whole days); expedited 16 hour(s) mean, 11 hour(s) median","note":"Whole percentages only, no counts, posted on a web page rather than a file. Standard decision times are in whole days, so they are kept as posted and not converted to hours. Molina also posts an expedited-appeal approval rate (30%) and an expedited extended-review rate (71%), which the table has no column for."},{"id":"molina-ma-h5823-wa","year":2025,"payer":"Molina Healthcare","program":"ma","report":"H5823 (WA)","part":null,"url":"https://www.molinahealthcare.com/providers/wa/prior-auth","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":93,"stdDeniedPct":7,"appeals":null,"appealApproved":null,"appealApprovedPct":65,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":83,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":90,"expDeniedPct":10,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":22,"expMedianHours":20,"timesAsPosted":"standard 3 day(s) mean, 2 day(s) median (whole days); expedited 22 hour(s) mean, 20 hour(s) median","note":"Whole percentages only, no counts, posted on a web page rather than a file. Standard decision times are in whole days, so they are kept as posted and not converted to hours. Molina also posts an expedited-appeal approval rate (71%) and an expedited extended-review rate (100%), which the table has no column for."},{"id":"aetna-medicaid-mco-fl","year":2025,"payer":"Aetna (CVS Health)","program":"medicaid-mco","report":"Aetna Better Health of Florida","part":null,"url":"https://www.aetnabetterhealth.com/content/dam/aetna/medicaid/florida/provider/pdf/2025_ABHFL_CMS_Web_Metrics_Provider_V2.pdf","readOn":"2026-10-07","stdRequests":43074,"stdApproved":33435,"stdDenied":9639,"stdApprovedPct":77.62,"stdDeniedPct":22.38,"appeals":1775,"appealApproved":432,"appealApprovedPct":24.33,"extendedRequests":1513,"extendedApproved":600,"extendedApprovedPct":39.66,"expRequests":6500,"expApproved":5199,"expDenied":1301,"expApprovedPct":79.98,"expDeniedPct":20.02,"stdAvgHours":73.2,"stdMedianHours":48,"expAvgHours":36.48,"expMedianHours":24,"timesAsPosted":"standard 3.05 day(s) mean, 2.0 day(s) median; expedited 1.52 day(s) mean, 1 day(s) median","note":"Counts and percentages; decision times in days to two decimals. The extended-review rate is out of the standard requests whose review was extended. Expedited requests whose review was extended: 21 approved of 67. The report gives 49,574 requests in all."},{"id":"aetna-medicaid-mco-il","year":2025,"payer":"Aetna (CVS Health)","program":"medicaid-mco","report":"Aetna Better Health of Illinois","part":null,"url":"https://www.aetnabetterhealth.com/content/dam/aetna/medicaid/illinois/providers/pdf/2025_ABHIL_CMS_Web_Metrics-Provider.pdf","readOn":"2026-10-07","stdRequests":110555,"stdApproved":93277,"stdDenied":17278,"stdApprovedPct":84.37,"stdDeniedPct":15.63,"appeals":3284,"appealApproved":432,"appealApprovedPct":13.15,"extendedRequests":2917,"extendedApproved":1562,"extendedApprovedPct":53.55,"expRequests":5187,"expApproved":4258,"expDenied":929,"expApprovedPct":82.09,"expDeniedPct":17.91,"stdAvgHours":30.72,"stdMedianHours":24,"expAvgHours":20.88,"expMedianHours":24,"timesAsPosted":"standard 1.28 day(s) mean, 1.0 day(s) median; expedited 0.87 day(s) mean, 1.0 day(s) median","note":"Counts and percentages; decision times in days to two decimals. The extended-review rate is out of the standard requests whose review was extended. Expedited requests whose review was extended: none. The report gives 115,736 requests in all."},{"id":"aetna-medicaid-mco-nj","year":2025,"payer":"Aetna (CVS Health)","program":"medicaid-mco","report":"Aetna Better Health of New Jersey","part":null,"url":"https://www.aetnabetterhealth.com/content/dam/aetna/medicaid/newjersey/providers/pdf/2025_ABHNJ_CMS_Web_Metrics-Provider_REM.pdf","readOn":"2026-10-07","stdRequests":55635,"stdApproved":40306,"stdDenied":15329,"stdApprovedPct":72.45,"stdDeniedPct":27.55,"appeals":2527,"appealApproved":380,"appealApprovedPct":15.03,"extendedRequests":0,"extendedApproved":0,"extendedApprovedPct":null,"expRequests":11289,"expApproved":9780,"expDenied":1509,"expApprovedPct":86.63,"expDeniedPct":13.37,"stdAvgHours":210.48,"stdMedianHours":240,"expAvgHours":13.92,"expMedianHours":0,"timesAsPosted":"standard 8.77 day(s) mean, 10.0 day(s) median; expedited 0.58 day(s) mean, 0.0 day(s) median","note":"Counts and percentages; decision times in days to two decimals. The extended-review rate is out of the standard requests whose review was extended. No standard request had its review extended. Expedited requests whose review was extended: none. The report gives 66,924 requests in all. The expedited denied count is printed a line below its label in the file."},{"id":"aetna-medicaid-mco-la","year":2025,"payer":"Aetna (CVS Health)","program":"medicaid-mco","report":"Aetna Better Health of Louisiana","part":null,"url":"https://www.aetnabetterhealth.com/content/dam/aetna/medicaid/louisiana/providers/pdf/2025_ABHLA_CMS_Web_Metrics-Provider.pdf","readOn":"2026-10-07","stdRequests":79506,"stdApproved":67439,"stdDenied":12067,"stdApprovedPct":84.82,"stdDeniedPct":15.18,"appeals":556,"appealApproved":164,"appealApprovedPct":29.49,"extendedRequests":102,"extendedApproved":58,"extendedApprovedPct":56.86,"expRequests":2062,"expApproved":1596,"expDenied":466,"expApprovedPct":77.4,"expDeniedPct":22.6,"stdAvgHours":54.96,"stdMedianHours":48,"expAvgHours":22.32,"expMedianHours":24,"timesAsPosted":"standard 2.29 day(s) mean, 2.0 day(s) median; expedited 0.93 day(s) mean, 1.0 day(s) median","note":"Counts and percentages; decision times in days to two decimals. The extended-review rate is out of the standard requests whose review was extended. Expedited requests whose review was extended: 28 approved of 42. The report gives 81,568 requests in all."},{"id":"aetna-medicaid-mco-ok","year":2025,"payer":"Aetna (CVS Health)","program":"medicaid-mco","report":"Aetna Better Health of Oklahoma","part":null,"url":"https://www.aetnabetterhealth.com/content/dam/aetna/medicaid/oklahoma/pdf/2025_ABHOK_CMS_Web_Metrics_Provider.pdf","readOn":"2026-10-07","stdRequests":64295,"stdApproved":57340,"stdDenied":6955,"stdApprovedPct":89.18,"stdDeniedPct":10.82,"appeals":1594,"appealApproved":288,"appealApprovedPct":18.06,"extendedRequests":3035,"extendedApproved":2026,"extendedApprovedPct":66.75,"expRequests":1354,"expApproved":1055,"expDenied":299,"expApprovedPct":77.92,"expDeniedPct":22.08,"stdAvgHours":45.84,"stdMedianHours":48,"expAvgHours":21.6,"expMedianHours":24,"timesAsPosted":"standard 1.91 day(s) mean, 2.0 day(s) median; expedited 0.90 day(s) mean, 1.0 day(s) median","note":"Counts and percentages; decision times in days to two decimals. The extended-review rate is out of the standard requests whose review was extended. Expedited requests whose review was extended: 15 approved of 35. The report gives 65,649 requests in all."},{"id":"aetna-medicaid-mco-ky","year":2025,"payer":"Aetna (CVS Health)","program":"medicaid-mco","report":"Aetna Better Health of Kentucky","part":null,"url":"https://www.aetnabetterhealth.com/content/dam/aetna/medicaid/kentucky/pdf/2025_ABHKY_CMS_Web_Metrics_Provider.pdf","readOn":"2026-10-07","stdRequests":123135,"stdApproved":99181,"stdDenied":23954,"stdApprovedPct":80.55,"stdDeniedPct":19.45,"appeals":1685,"appealApproved":609,"appealApprovedPct":36.14,"extendedRequests":127,"extendedApproved":81,"extendedApprovedPct":63.78,"expRequests":19329,"expApproved":16114,"expDenied":3215,"expApprovedPct":83.37,"expDeniedPct":16.63,"stdAvgHours":47.76,"stdMedianHours":48,"expAvgHours":38.64,"expMedianHours":24,"timesAsPosted":"standard 1.99 day(s) mean, 2.0 day(s) median; expedited 1.61 day(s) mean, 1.0 day(s) median","note":"Counts and percentages; decision times in days to two decimals. The extended-review rate is out of the standard requests whose review was extended. Expedited requests whose review was extended: none. The report gives 142,463 requests in all."},{"id":"aetna-medicaid-mco-mi","year":2025,"payer":"Aetna (CVS Health)","program":"medicaid-mco","report":"Aetna Better Health of Michigan","part":null,"url":"https://www.aetnabetterhealth.com/content/dam/aetna/medicaid/michigan/pdf/abhmi_2025_cms_web_metrics_provider.pdf","readOn":"2026-10-07","stdRequests":18381,"stdApproved":14313,"stdDenied":4068,"stdApprovedPct":77.87,"stdDeniedPct":22.13,"appeals":460,"appealApproved":126,"appealApprovedPct":27.39,"extendedRequests":0,"extendedApproved":0,"extendedApprovedPct":null,"expRequests":1095,"expApproved":893,"expDenied":202,"expApprovedPct":81.55,"expDeniedPct":18.45,"stdAvgHours":89.04,"stdMedianHours":48,"expAvgHours":24,"expMedianHours":24,"timesAsPosted":"standard 3.71 day(s) mean, 2.0 day(s) median; expedited 1.0 day(s) mean, 1.0 day(s) median","note":"Counts and percentages; decision times in days to two decimals. The extended-review rate is out of the standard requests whose review was extended. No standard request had its review extended. Expedited requests whose review was extended: none. The report gives 19,476 requests in all."},{"id":"aetna-medicaid-mco-tx","year":2025,"payer":"Aetna (CVS Health)","program":"medicaid-mco","report":"Aetna Better Health of Texas","part":null,"url":"https://www.aetnabetterhealth.com/content/dam/aetna/pdfs/2025_ABHTX_CMS_Web_Metrics-Provider.pdf","readOn":"2026-10-07","stdRequests":41416,"stdApproved":38229,"stdDenied":3187,"stdApprovedPct":92.3,"stdDeniedPct":7.7,"appeals":448,"appealApproved":162,"appealApprovedPct":36.16,"extendedRequests":4027,"extendedApproved":2977,"extendedApprovedPct":73.93,"expRequests":1972,"expApproved":1827,"expDenied":145,"expApprovedPct":92.65,"expDeniedPct":7.35,"stdAvgHours":81.6,"stdMedianHours":72,"expAvgHours":43.92,"expMedianHours":24,"timesAsPosted":"standard 3.40 day(s) mean, 3.0 day(s) median; expedited 1.83 day(s) mean, 1.0 day(s) median","note":"Counts and percentages; decision times in days to two decimals. The extended-review rate is out of the standard requests whose review was extended. Expedited requests whose review was extended: 148 approved of 206. The report gives 43,387 requests in all."},{"id":"aetna-medicaid-mco-md","year":2025,"payer":"Aetna (CVS Health)","program":"medicaid-mco","report":"Aetna Better Health of Maryland","part":null,"url":"https://www.aetnabetterhealth.com/content/dam/aetna/pdfs/2025_ABHMD_CMS_Web_Metrics-Provider.pdf","readOn":"2026-10-07","stdRequests":16105,"stdApproved":12367,"stdDenied":3738,"stdApprovedPct":76.79,"stdDeniedPct":23.21,"appeals":428,"appealApproved":78,"appealApprovedPct":18.22,"extendedRequests":2717,"extendedApproved":1372,"extendedApprovedPct":50.5,"expRequests":1473,"expApproved":1023,"expDenied":450,"expApprovedPct":69.45,"expDeniedPct":30.55,"stdAvgHours":43.92,"stdMedianHours":24,"expAvgHours":31.68,"expMedianHours":24,"timesAsPosted":"standard 1.83 day(s) mean, 1.0 day(s) median; expedited 1.32 day(s) mean, 1.0 day(s) median","note":"Counts and percentages; decision times in days to two decimals. The extended-review rate is out of the standard requests whose review was extended. Expedited requests whose review was extended: 59 approved of 109. The report gives 17,578 requests in all."},{"id":"aetna-chip-mco-pa","year":2025,"payer":"Aetna (CVS Health)","program":"chip-mco","report":"Aetna Better Health Kids (PA)","part":null,"url":"https://www.aetnabetterhealth.com/content/dam/aetna/pdfs/2025_ABHPA%20CHIP_CMS_Web_Metrics-Provider.pdf","readOn":"2026-10-07","stdRequests":2066,"stdApproved":1695,"stdDenied":371,"stdApprovedPct":82.04,"stdDeniedPct":17.96,"appeals":153,"appealApproved":68,"appealApprovedPct":44.44,"extendedRequests":44,"extendedApproved":23,"extendedApprovedPct":52.27,"expRequests":2990,"expApproved":2445,"expDenied":545,"expApprovedPct":81.77,"expDeniedPct":18.23,"stdAvgHours":47.28,"stdMedianHours":24,"expAvgHours":51.12,"expMedianHours":48,"timesAsPosted":"standard 1.97 day(s) mean, 1.0 day(s) median; expedited 2.13 day(s) mean, 2.0 day(s) median","note":"Counts and percentages; decision times in days to two decimals. The extended-review rate is out of the standard requests whose review was extended. Expedited requests whose review was extended: none. The report gives 5,056 requests in all. Expedited requests outnumber standard ones in this report, as posted."},{"id":"aetna-mmp-h8026","year":2025,"payer":"Aetna (CVS Health)","program":"mmp","report":"H8026 Aetna Better Health Premier Plan (MI)","part":null,"url":"https://www.aetnabetterhealth.com/content/dam/aetna/pdfs/PA%20metric%20reporting%20template%20MA%20v3%20Approved_H8026.pdf","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":94.13,"stdDeniedPct":5.87,"appeals":null,"appealApproved":null,"appealApprovedPct":33.33,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":96.19,"expDeniedPct":3.81,"stdAvgHours":99.6,"stdMedianHours":48,"expAvgHours":38.64,"expMedianHours":24,"timesAsPosted":"standard 4.15 day(s) mean, 2.0 day(s) median; expedited 1.61 day(s) mean, 1.0 day(s) median","note":"Percentages only, no counts. The extended-review rate is posted as \"none\"."},{"id":"excellus-chp","year":2025,"payer":"Excellus BlueCross BlueShield","program":"chip-mco","report":"Excellus BCBS Child Health Plus, New York","part":null,"url":"https://www.excellusbcbs.com/documents/d/global/excellusmetrics2025","readOn":"2026-10-07","stdRequests":18319,"stdApproved":15667,"stdDenied":2652,"stdApprovedPct":85.5,"stdDeniedPct":14.5,"appeals":112,"appealApproved":16,"appealApprovedPct":14.3,"extendedRequests":1768,"extendedApproved":1529,"extendedApprovedPct":86.5,"expRequests":73,"expApproved":60,"expDenied":13,"expApprovedPct":82.2,"expDeniedPct":17.8,"stdAvgHours":38.4,"stdMedianHours":33.6,"expAvgHours":14.4,"expMedianHours":2.4,"timesAsPosted":"standard 1.6 days mean, 1.4 days median; expedited 0.6 days mean, 0.1 days median","note":"Times are printed as bare numbers under column headers \"Avg Days\" / \"Median Days\"; unit \"days\" taken from the header. Extended-review row is not labeled standard vs expedited (column D: \"prior authorization requests with extended review timeframes\")."},{"id":"excellus-mmc","year":2025,"payer":"Excellus BlueCross BlueShield","program":"medicaid-mco","report":"Excellus BCBS Managed Medicaid, New York","part":null,"url":"https://www.excellusbcbs.com/documents/d/global/excellusmetrics2025","readOn":"2026-10-07","stdRequests":126221,"stdApproved":107238,"stdDenied":18983,"stdApprovedPct":85,"stdDeniedPct":15,"appeals":705,"appealApproved":130,"appealApprovedPct":18.4,"extendedRequests":20067,"extendedApproved":17716,"extendedApprovedPct":88.3,"expRequests":918,"expApproved":686,"expDenied":232,"expApprovedPct":74.7,"expDeniedPct":25.3,"stdAvgHours":33.6,"stdMedianHours":28.8,"expAvgHours":16.8,"expMedianHours":7.2,"timesAsPosted":"standard 1.4 days mean, 1.2 days median; expedited 0.7 days mean, 0.3 days median","note":"Times are printed as bare numbers under column headers \"Avg Days\" / \"Median Days\"; unit \"days\" taken from the header. Extended-review row is not labeled standard vs expedited (column D: \"prior authorization requests with extended review timeframes\")."},{"id":"excellus-harp","year":2025,"payer":"Excellus BlueCross BlueShield","program":"medicaid-mco","report":"Excellus BCBS Blue Option Plus, New York","part":null,"url":"https://www.excellusbcbs.com/documents/d/global/excellusmetrics2025","readOn":"2026-10-07","stdRequests":17806,"stdApproved":15512,"stdDenied":2294,"stdApprovedPct":87.1,"stdDeniedPct":12.9,"appeals":100,"appealApproved":10,"appealApprovedPct":10,"extendedRequests":3684,"extendedApproved":3224,"extendedApprovedPct":87.5,"expRequests":108,"expApproved":99,"expDenied":9,"expApprovedPct":91.7,"expDeniedPct":8.3,"stdAvgHours":31.2,"stdMedianHours":24,"expAvgHours":12,"expMedianHours":7.2,"timesAsPosted":"standard 1.3 days mean, 1.0 days median; expedited 0.5 days mean, 0.3 days median","note":"Times are printed as bare numbers under column headers \"Avg Days\" / \"Median Days\"; unit \"days\" taken from the header. Extended-review row is not labeled standard vs expedited (column D: \"prior authorization requests with extended review timeframes\"). HARP (Health and Recovery Plan) is a NY Medicaid managed care product."},{"id":"excellus-ma-h3351","year":2025,"payer":"Excellus BlueCross BlueShield","program":"ma","report":"H3351 Medicare HMO","part":null,"url":"https://www.excellusbcbs.com/documents/d/global/excellusmetrics2025","readOn":"2026-10-07","stdRequests":103135,"stdApproved":98076,"stdDenied":5059,"stdApprovedPct":95.1,"stdDeniedPct":4.9,"appeals":916,"appealApproved":277,"appealApprovedPct":30.2,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":5092,"expApproved":4278,"expDenied":814,"expApprovedPct":84,"expDeniedPct":16,"stdAvgHours":21.6,"stdMedianHours":0,"expAvgHours":14.4,"expMedianHours":4.8,"timesAsPosted":"standard 0.9 days mean, 0.0 days median; expedited 0.6 days mean, 0.2 days median","note":"Times are printed as bare numbers under column headers \"Avg Days\" / \"Median Days\"; unit \"days\" taken from the header. Extended-review columns print \".\" (no figure) for this Medicare contract. Extended-review row is not labeled standard vs expedited (column D: \"prior authorization requests with extended review timeframes\"). Univera Healthcare publishes separate figures under the same contract id."},{"id":"excellus-ma-h3335","year":2025,"payer":"Excellus BlueCross BlueShield","program":"ma","report":"H3335 Medicare PPO","part":null,"url":"https://www.excellusbcbs.com/documents/d/global/excellusmetrics2025","readOn":"2026-10-07","stdRequests":117729,"stdApproved":110482,"stdDenied":7247,"stdApprovedPct":93.8,"stdDeniedPct":6.2,"appeals":1445,"appealApproved":417,"appealApprovedPct":28.9,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":6240,"expApproved":5288,"expDenied":952,"expApprovedPct":84.7,"expDeniedPct":15.3,"stdAvgHours":24,"stdMedianHours":0,"expAvgHours":14.4,"expMedianHours":4.8,"timesAsPosted":"standard 1.0 days mean, 0.0 days median; expedited 0.6 days mean, 0.2 days median","note":"Times are printed as bare numbers under column headers \"Avg Days\" / \"Median Days\"; unit \"days\" taken from the header. Extended-review columns print \".\" (no figure) for this Medicare contract. Extended-review row is not labeled standard vs expedited (column D: \"prior authorization requests with extended review timeframes\"). Univera Healthcare publishes separate figures under the same contract id."},{"id":"excellus-ma-h7524","year":2025,"payer":"Excellus BlueCross BlueShield","program":"ma","report":"H7524 Medicare DSNP HMO","part":null,"url":"https://www.excellusbcbs.com/documents/d/global/excellusmetrics2025","readOn":"2026-10-07","stdRequests":2327,"stdApproved":1645,"stdDenied":682,"stdApprovedPct":70.7,"stdDeniedPct":29.3,"appeals":27,"appealApproved":6,"appealApprovedPct":22.2,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":29,"expApproved":24,"expDenied":5,"expApprovedPct":82.8,"expDeniedPct":17.2,"stdAvgHours":43.2,"stdMedianHours":24,"expAvgHours":16.8,"expMedianHours":19.2,"timesAsPosted":"standard 1.8 days mean, 1.0 days median; expedited 0.7 days mean, 0.8 days median","note":"Times are printed as bare numbers under column headers \"Avg Days\" / \"Median Days\"; unit \"days\" taken from the header. Extended-review columns print \".\" (no figure) for this Medicare contract. Extended-review row is not labeled standard vs expedited (column D: \"prior authorization requests with extended review timeframes\"). D-SNP contract. Univera Healthcare publishes separate figures under the same contract id."},{"id":"univera-chp","year":2025,"payer":"Univera Healthcare","program":"chip-mco","report":"Univera Child Health Plus, New York","part":null,"url":"https://www.excellusbcbs.com/documents/d/global/univerametrics2025","readOn":"2026-10-07","stdRequests":215,"stdApproved":201,"stdDenied":14,"stdApprovedPct":93.5,"stdDeniedPct":6.5,"appeals":1,"appealApproved":null,"appealApprovedPct":null,"extendedRequests":33,"extendedApproved":27,"extendedApprovedPct":81.8,"expRequests":8,"expApproved":8,"expDenied":null,"expApprovedPct":100,"expDeniedPct":null,"stdAvgHours":38.4,"stdMedianHours":33.6,"expAvgHours":26.4,"expMedianHours":26.4,"timesAsPosted":"standard 1.6 days mean, 1.4 days median; expedited 1.1 days mean, 1.1 days median","note":"Times are printed as bare numbers under column headers \"Avg Days\" / \"Median Days\"; unit \"days\" taken from the header. Appeals: count 1 printed, approved and % print \".\" (no figure; likely zero). Expedited denied count and % print \".\" (no figure; likely zero). Extended-review row is not labeled standard vs expedited (column D: \"prior authorization requests with extended review timeframes\"). Univera Healthcare report."},{"id":"univera-mmc","year":2025,"payer":"Univera Healthcare","program":"medicaid-mco","report":"Univera Healthcare MyHealth, New York","part":null,"url":"https://www.excellusbcbs.com/documents/d/global/univerametrics2025","readOn":"2026-10-07","stdRequests":4910,"stdApproved":4127,"stdDenied":783,"stdApprovedPct":84.1,"stdDeniedPct":15.9,"appeals":26,"appealApproved":2,"appealApprovedPct":7.7,"extendedRequests":678,"extendedApproved":590,"extendedApprovedPct":87,"expRequests":54,"expApproved":47,"expDenied":7,"expApprovedPct":87,"expDeniedPct":13,"stdAvgHours":31.2,"stdMedianHours":28.8,"expAvgHours":9.6,"expMedianHours":2.4,"timesAsPosted":"standard 1.3 days mean, 1.2 days median; expedited 0.4 days mean, 0.1 days median","note":"Times are printed as bare numbers under column headers \"Avg Days\" / \"Median Days\"; unit \"days\" taken from the header. Extended-review row is not labeled standard vs expedited (column D: \"prior authorization requests with extended review timeframes\"). Univera Healthcare report."},{"id":"univera-harp","year":2025,"payer":"Univera Healthcare","program":"medicaid-mco","report":"Univera Healthcare MyHealth Plus, New York","part":null,"url":"https://www.excellusbcbs.com/documents/d/global/univerametrics2025","readOn":"2026-10-07","stdRequests":498,"stdApproved":433,"stdDenied":65,"stdApprovedPct":86.9,"stdDeniedPct":13.1,"appeals":2,"appealApproved":null,"appealApprovedPct":null,"extendedRequests":91,"extendedApproved":74,"extendedApprovedPct":81.3,"expRequests":8,"expApproved":8,"expDenied":null,"expApprovedPct":100,"expDeniedPct":null,"stdAvgHours":26.4,"stdMedianHours":21.6,"expAvgHours":4.8,"expMedianHours":2.4,"timesAsPosted":"standard 1.1 days mean, 0.9 days median; expedited 0.2 days mean, 0.1 days median","note":"Times are printed as bare numbers under column headers \"Avg Days\" / \"Median Days\"; unit \"days\" taken from the header. Appeals: count 2 printed, approved and % print \".\" (no figure; likely zero). Expedited denied count and % print \".\" (no figure; likely zero). Extended-review row is not labeled standard vs expedited (column D: \"prior authorization requests with extended review timeframes\"). HARP (Health and Recovery Plan) is a NY Medicaid managed care product. Univera Healthcare report."},{"id":"univera-ma-h3351","year":2025,"payer":"Univera Healthcare","program":"ma","report":"H3351 Medicare HMO","part":null,"url":"https://www.excellusbcbs.com/documents/d/global/univerametrics2025","readOn":"2026-10-07","stdRequests":32879,"stdApproved":31228,"stdDenied":1651,"stdApprovedPct":95,"stdDeniedPct":5,"appeals":315,"appealApproved":90,"appealApprovedPct":28.6,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":847,"expApproved":733,"expDenied":114,"expApprovedPct":86.5,"expDeniedPct":13.5,"stdAvgHours":21.6,"stdMedianHours":0,"expAvgHours":16.8,"expMedianHours":2.4,"timesAsPosted":"standard 0.9 days mean, 0.0 days median; expedited 0.7 days mean, 0.1 days median","note":"Times are printed as bare numbers under column headers \"Avg Days\" / \"Median Days\"; unit \"days\" taken from the header. Extended-review columns print \".\" (no figure) for this Medicare contract. Extended-review row is not labeled standard vs expedited (column D: \"prior authorization requests with extended review timeframes\"). Univera Healthcare reports under the same Medicare contract ids as Excellus BCBS; figures are Univera's own."},{"id":"univera-ma-h3335","year":2025,"payer":"Univera Healthcare","program":"ma","report":"H3335 Medicare PPO","part":null,"url":"https://www.excellusbcbs.com/documents/d/global/univerametrics2025","readOn":"2026-10-07","stdRequests":3301,"stdApproved":3095,"stdDenied":206,"stdApprovedPct":93.8,"stdDeniedPct":6.2,"appeals":43,"appealApproved":7,"appealApprovedPct":16.3,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":101,"expApproved":89,"expDenied":12,"expApprovedPct":88.1,"expDeniedPct":11.9,"stdAvgHours":21.6,"stdMedianHours":0,"expAvgHours":12,"expMedianHours":2.4,"timesAsPosted":"standard 0.9 days mean, 0.0 days median; expedited 0.5 days mean, 0.1 days median","note":"Times are printed as bare numbers under column headers \"Avg Days\" / \"Median Days\"; unit \"days\" taken from the header. Extended-review columns print \".\" (no figure) for this Medicare contract. Extended-review row is not labeled standard vs expedited (column D: \"prior authorization requests with extended review timeframes\"). Univera Healthcare reports under the same Medicare contract ids as Excellus BCBS; figures are Univera's own."},{"id":"univera-ma-h7524","year":2025,"payer":"Univera Healthcare","program":"ma","report":"H7524 Medicare DSNP HMO","part":null,"url":"https://www.excellusbcbs.com/documents/d/global/univerametrics2025","readOn":"2026-10-07","stdRequests":118,"stdApproved":75,"stdDenied":43,"stdApprovedPct":63.6,"stdDeniedPct":36.4,"appeals":3,"appealApproved":1,"appealApprovedPct":33.3,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":3,"expApproved":3,"expDenied":null,"expApprovedPct":100,"expDeniedPct":null,"stdAvgHours":60,"stdMedianHours":48,"expAvgHours":36,"expMedianHours":45.6,"timesAsPosted":"standard 2.5 days mean, 2.0 days median; expedited 1.5 days mean, 1.9 days median","note":"Times are printed as bare numbers under column headers \"Avg Days\" / \"Median Days\"; unit \"days\" taken from the header. Extended-review columns print \".\" (no figure) for this Medicare contract. Expedited denied count and % print \".\" (no figure; likely zero). Extended-review row is not labeled standard vs expedited (column D: \"prior authorization requests with extended review timeframes\"). D-SNP contract. Univera Healthcare reports under the same Medicare contract ids as Excellus BCBS; figures are Univera's own."},{"id":"hp-mn-medicaid","year":2025,"payer":"HealthPartners","program":"medicaid-mco","report":"Minnesota Health Care Programs (Medicaid)","part":null,"url":"https://www.healthpartners.com/content/dam/corporate/integrity-compliance/pa-reporting-cy2025-ma-medadv-msho-indwionexch.pdf","readOn":"2026-10-07","stdRequests":11816,"stdApproved":10807,"stdDenied":1009,"stdApprovedPct":91,"stdDeniedPct":9,"appeals":247,"appealApproved":96,"appealApprovedPct":39,"extendedRequests":0,"extendedApproved":0,"extendedApprovedPct":null,"expRequests":1992,"expApproved":1884,"expDenied":108,"expApprovedPct":95,"expDeniedPct":5,"stdAvgHours":72,"stdMedianHours":0,"expAvgHours":10.58,"expMedianHours":2.1,"timesAsPosted":"standard 3 days mean, 0 days median; expedited 10.58 hours mean, 2.10 hours median","note":"Percentages printed as whole numbers. Extension rows print 0 of 0 with \"0%\" for both standard and expedited. Expedited appeals (not in schema): approved 8 of 14 (57%). The file posts extendedApprovedPct as 0% over zero requests; carried as no rate.","ratePrecision":{"stdApprovedPct":0,"stdDeniedPct":0,"expApprovedPct":0,"expDeniedPct":0,"appealApprovedPct":0}},{"id":"hp-ma-msho","year":2025,"payer":"HealthPartners","program":"ma","report":"Medicare Advantage and Minnesota Senior Health Option (MSHO)","part":null,"url":"https://www.healthpartners.com/content/dam/corporate/integrity-compliance/pa-reporting-cy2025-ma-medadv-msho-indwionexch.pdf","readOn":"2026-10-07","stdRequests":11994,"stdApproved":11241,"stdDenied":753,"stdApprovedPct":94,"stdDeniedPct":6,"appeals":203,"appealApproved":175,"appealApprovedPct":86,"extendedRequests":0,"extendedApproved":0,"extendedApprovedPct":null,"expRequests":1151,"expApproved":1082,"expDenied":69,"expApprovedPct":94,"expDeniedPct":6,"stdAvgHours":48,"stdMedianHours":0,"expAvgHours":7.72,"expMedianHours":0.09,"timesAsPosted":"standard 2 days mean, 0 days median; expedited 7.72 hours mean, 0.09 hours median","note":"Percentages printed as whole numbers. Extension rows print 0 of 0 with \"0%\" for both standard and expedited. One combined report for all Medicare Advantage and MSHO (dual-eligible) plans; no contract ids given. Expedited appeals (not in schema): approved 15 of 22 (68%). The file posts extendedApprovedPct as 0% over zero requests; carried as no rate.","ratePrecision":{"stdApprovedPct":0,"stdDeniedPct":0,"appealApprovedPct":0}},{"id":"hp-wi-qhp","year":2025,"payer":"HealthPartners","program":"qhp","report":"HealthPartners Commercial WI Federally Facilitated Exchange Products (Wisconsin)","part":null,"url":"https://www.healthpartners.com/content/dam/corporate/integrity-compliance/pa-reporting-cy2025-ma-medadv-msho-indwionexch.pdf","readOn":"2026-10-07","stdRequests":1172,"stdApproved":1011,"stdDenied":161,"stdApprovedPct":86,"stdDeniedPct":14,"appeals":19,"appealApproved":16,"appealApprovedPct":84,"extendedRequests":0,"extendedApproved":0,"extendedApprovedPct":null,"expRequests":108,"expApproved":92,"expDenied":16,"expApprovedPct":85,"expDeniedPct":15,"stdAvgHours":96,"stdMedianHours":0,"expAvgHours":21.68,"expMedianHours":0.72,"timesAsPosted":"standard 4 days mean, 0 days median; expedited 21.68 hours mean, 0.72 hours median","note":"Percentages printed as whole numbers. Extension rows print 0 of 0 with \"0%\" for both standard and expedited. Expedited appeals (not in schema): approved 0 of 1 (0%). The file posts extendedApprovedPct as 0% over zero requests; carried as no rate.","ratePrecision":{"stdApprovedPct":0,"stdDeniedPct":0,"expApprovedPct":0,"expDeniedPct":0,"appealApprovedPct":0}},{"id":"devoted-ma-h1290","year":2025,"payer":"Devoted Health","program":"ma","report":"H1290","part":null,"url":"https://assets.devoted.com/UM/2025/um-metrics","readOn":"2026-10-07","stdRequests":43724,"stdApproved":36771,"stdDenied":6953,"stdApprovedPct":84.1,"stdDeniedPct":15.9,"appeals":null,"appealApproved":139,"appealApprovedPct":2,"extendedRequests":null,"extendedApproved":0,"extendedApprovedPct":0,"expRequests":5082,"expApproved":4637,"expDenied":445,"expApprovedPct":91.24,"expDeniedPct":8.76,"stdAvgHours":40.8,"stdMedianHours":24,"expAvgHours":7.9,"expMedianHours":2,"timesAsPosted":"standard 1.7 days mean, 1 day median; expedited 7.9 hours mean, 2 hours median","note":"Appeals: the file prints \"Number of appealed auths overturned\" and an \"Overturn rate\" but not the number of appeals; the overturn rate matches overturned / denied requests, so appealApprovedPct uses denied requests as denominator. Overturn rates are printed with two decimals but always end in 0 (e.g. \"8.10%\"); they match overturned/denied at one decimal. Expedited appeals overturned (not in schema): 50, overturn rate 11.20%. Extension figures come from a file-wide note, not this contract's row: \"Across all contracts, we had 0 requests approved following an extension, and therefore a 0% extension request overall approval rate.\" It covers standard and expedited; extension request counts are not printed. Times printed as bare numbers; units taken from column headers \"time (days)\" for standard and \"time (hours)\" for expedited. No plan name printed; contract id only. The overturn rate is out of denied requests, not appeals, so it is left out of the market summary.","notPooled":["appealApprovedPct"]},{"id":"devoted-ma-h2697","year":2025,"payer":"Devoted Health","program":"ma","report":"H2697","part":null,"url":"https://assets.devoted.com/UM/2025/um-metrics","readOn":"2026-10-07","stdRequests":21443,"stdApproved":20382,"stdDenied":1061,"stdApprovedPct":95.05,"stdDeniedPct":4.95,"appeals":null,"appealApproved":86,"appealApprovedPct":8.1,"extendedRequests":null,"extendedApproved":0,"extendedApprovedPct":0,"expRequests":1322,"expApproved":1153,"expDenied":169,"expApprovedPct":87.22,"expDeniedPct":12.78,"stdAvgHours":33.6,"stdMedianHours":2.4,"expAvgHours":9.7,"expMedianHours":4,"timesAsPosted":"standard 1.4 days mean, 0.1 days median; expedited 9.7 hours mean, 4 hours median","note":"Appeals: the file prints \"Number of appealed auths overturned\" and an \"Overturn rate\" but not the number of appeals; the overturn rate matches overturned / denied requests, so appealApprovedPct uses denied requests as denominator. Overturn rates are printed with two decimals but always end in 0 (e.g. \"8.10%\"); they match overturned/denied at one decimal. Expedited appeals overturned (not in schema): 20, overturn rate 11.80%. Extension figures come from a file-wide note, not this contract's row: \"Across all contracts, we had 0 requests approved following an extension, and therefore a 0% extension request overall approval rate.\" It covers standard and expedited; extension request counts are not printed. Times printed as bare numbers; units taken from column headers \"time (days)\" for standard and \"time (hours)\" for expedited. No plan name printed; contract id only. The overturn rate is out of denied requests, not appeals, so it is left out of the market summary.","notPooled":["appealApprovedPct"]},{"id":"devoted-ma-h7993","year":2025,"payer":"Devoted Health","program":"ma","report":"H7993","part":null,"url":"https://assets.devoted.com/UM/2025/um-metrics","readOn":"2026-10-07","stdRequests":20484,"stdApproved":18671,"stdDenied":1813,"stdApprovedPct":91.15,"stdDeniedPct":8.85,"appeals":null,"appealApproved":124,"appealApprovedPct":6.8,"extendedRequests":null,"extendedApproved":0,"extendedApprovedPct":0,"expRequests":2975,"expApproved":2648,"expDenied":327,"expApprovedPct":89.01,"expDeniedPct":10.99,"stdAvgHours":36,"stdMedianHours":2.4,"expAvgHours":9,"expMedianHours":2,"timesAsPosted":"standard 1.5 days mean, 0.1 days median; expedited 9 hours mean, 2 hours median","note":"Appeals: the file prints \"Number of appealed auths overturned\" and an \"Overturn rate\" but not the number of appeals; the overturn rate matches overturned / denied requests, so appealApprovedPct uses denied requests as denominator. Overturn rates are printed with two decimals but always end in 0 (e.g. \"8.10%\"); they match overturned/denied at one decimal. Expedited appeals overturned (not in schema): 41, overturn rate 12.50%. Extension figures come from a file-wide note, not this contract's row: \"Across all contracts, we had 0 requests approved following an extension, and therefore a 0% extension request overall approval rate.\" It covers standard and expedited; extension request counts are not printed. Times printed as bare numbers; units taken from column headers \"time (days)\" for standard and \"time (hours)\" for expedited. No plan name printed; contract id only. The overturn rate is out of denied requests, not appeals, so it is left out of the market summary.","notPooled":["appealApprovedPct"]},{"id":"devoted-ma-h3080","year":2025,"payer":"Devoted Health","program":"ma","report":"H3080","part":null,"url":"https://assets.devoted.com/UM/2025/um-metrics","readOn":"2026-10-07","stdRequests":9294,"stdApproved":8451,"stdDenied":843,"stdApprovedPct":90.93,"stdDeniedPct":9.07,"appeals":null,"appealApproved":61,"appealApprovedPct":7.2,"extendedRequests":null,"extendedApproved":0,"extendedApprovedPct":0,"expRequests":1120,"expApproved":902,"expDenied":218,"expApprovedPct":80.54,"expDeniedPct":19.46,"stdAvgHours":28.8,"stdMedianHours":2.4,"expAvgHours":9.7,"expMedianHours":3,"timesAsPosted":"standard 1.2 days mean, 0.1 days median; expedited 9.7 hours mean, 3 hours median","note":"Appeals: the file prints \"Number of appealed auths overturned\" and an \"Overturn rate\" but not the number of appeals; the overturn rate matches overturned / denied requests, so appealApprovedPct uses denied requests as denominator. Overturn rates are printed with two decimals but always end in 0 (e.g. \"8.10%\"); they match overturned/denied at one decimal. Expedited appeals overturned (not in schema): 15, overturn rate 6.90%. Extension figures come from a file-wide note, not this contract's row: \"Across all contracts, we had 0 requests approved following an extension, and therefore a 0% extension request overall approval rate.\" It covers standard and expedited; extension request counts are not printed. Times printed as bare numbers; units taken from column headers \"time (days)\" for standard and \"time (hours)\" for expedited. No plan name printed; contract id only. The overturn rate is out of denied requests, not appeals, so it is left out of the market summary.","notPooled":["appealApprovedPct"]},{"id":"devoted-ma-h8173","year":2025,"payer":"Devoted Health","program":"ma","report":"H8173","part":null,"url":"https://assets.devoted.com/UM/2025/um-metrics","readOn":"2026-10-07","stdRequests":5953,"stdApproved":5646,"stdDenied":307,"stdApprovedPct":94.84,"stdDeniedPct":5.16,"appeals":null,"appealApproved":25,"appealApprovedPct":8.1,"extendedRequests":null,"extendedApproved":0,"extendedApprovedPct":0,"expRequests":1308,"expApproved":1224,"expDenied":84,"expApprovedPct":93.58,"expDeniedPct":6.42,"stdAvgHours":33.6,"stdMedianHours":4.8,"expAvgHours":8,"expMedianHours":2,"timesAsPosted":"standard 1.4 days mean, 0.2 days median; expedited 8 hours mean, 2 hours median","note":"Appeals: the file prints \"Number of appealed auths overturned\" and an \"Overturn rate\" but not the number of appeals; the overturn rate matches overturned / denied requests, so appealApprovedPct uses denied requests as denominator. Overturn rates are printed with two decimals but always end in 0 (e.g. \"8.10%\"); they match overturned/denied at one decimal. Expedited appeals overturned (not in schema): 8, overturn rate 9.50%. Extension figures come from a file-wide note, not this contract's row: \"Across all contracts, we had 0 requests approved following an extension, and therefore a 0% extension request overall approval rate.\" It covers standard and expedited; extension request counts are not printed. Times printed as bare numbers; units taken from column headers \"time (days)\" for standard and \"time (hours)\" for expedited. No plan name printed; contract id only. The overturn rate is out of denied requests, not appeals, so it is left out of the market summary.","notPooled":["appealApprovedPct"]},{"id":"devoted-ma-h7147","year":2025,"payer":"Devoted Health","program":"ma","report":"H7147","part":null,"url":"https://assets.devoted.com/UM/2025/um-metrics","readOn":"2026-10-07","stdRequests":5488,"stdApproved":5136,"stdDenied":352,"stdApprovedPct":93.59,"stdDeniedPct":6.41,"appeals":null,"appealApproved":35,"appealApprovedPct":9.9,"extendedRequests":null,"extendedApproved":0,"extendedApprovedPct":0,"expRequests":608,"expApproved":507,"expDenied":101,"expApprovedPct":83.39,"expDeniedPct":16.61,"stdAvgHours":33.6,"stdMedianHours":0,"expAvgHours":11.1,"expMedianHours":4,"timesAsPosted":"standard 1.4 days mean, 0 days median; expedited 11.1 hours mean, 4 hours median","note":"Appeals: the file prints \"Number of appealed auths overturned\" and an \"Overturn rate\" but not the number of appeals; the overturn rate matches overturned / denied requests, so appealApprovedPct uses denied requests as denominator. Overturn rates are printed with two decimals but always end in 0 (e.g. \"8.10%\"); they match overturned/denied at one decimal. Expedited appeals overturned (not in schema): 11, overturn rate 10.90%. Extension figures come from a file-wide note, not this contract's row: \"Across all contracts, we had 0 requests approved following an extension, and therefore a 0% extension request overall approval rate.\" It covers standard and expedited; extension request counts are not printed. Times printed as bare numbers; units taken from column headers \"time (days)\" for standard and \"time (hours)\" for expedited. No plan name printed; contract id only. The overturn rate is out of denied requests, not appeals, so it is left out of the market summary.","notPooled":["appealApprovedPct"]},{"id":"devoted-ma-h7028","year":2025,"payer":"Devoted Health","program":"ma","report":"H7028","part":null,"url":"https://assets.devoted.com/UM/2025/um-metrics","readOn":"2026-10-07","stdRequests":5253,"stdApproved":5133,"stdDenied":120,"stdApprovedPct":97.72,"stdDeniedPct":2.28,"appeals":null,"appealApproved":15,"appealApprovedPct":12.5,"extendedRequests":null,"extendedApproved":0,"extendedApprovedPct":0,"expRequests":407,"expApproved":391,"expDenied":16,"expApprovedPct":96.07,"expDeniedPct":3.93,"stdAvgHours":26.4,"stdMedianHours":0,"expAvgHours":25.6,"expMedianHours":2,"timesAsPosted":"standard 1.1 days mean, 0 days median; expedited 25.6 hours mean, 2 hours median","note":"Appeals: the file prints \"Number of appealed auths overturned\" and an \"Overturn rate\" but not the number of appeals; the overturn rate matches overturned / denied requests, so appealApprovedPct uses denied requests as denominator. Overturn rates are printed with two decimals but always end in 0 (e.g. \"8.10%\"); they match overturned/denied at one decimal. Expedited appeals overturned (not in schema): 0, overturn rate 0.00%. Extension figures come from a file-wide note, not this contract's row: \"Across all contracts, we had 0 requests approved following an extension, and therefore a 0% extension request overall approval rate.\" It covers standard and expedited; extension request counts are not printed. Times printed as bare numbers; units taken from column headers \"time (days)\" for standard and \"time (hours)\" for expedited. No plan name printed; contract id only. The overturn rate is out of denied requests, not appeals, so it is left out of the market summary.","notPooled":["appealApprovedPct"]},{"id":"devoted-ma-h4808","year":2025,"payer":"Devoted Health","program":"ma","report":"H4808","part":null,"url":"https://assets.devoted.com/UM/2025/um-metrics","readOn":"2026-10-07","stdRequests":4955,"stdApproved":4823,"stdDenied":132,"stdApprovedPct":97.34,"stdDeniedPct":2.66,"appeals":null,"appealApproved":14,"appealApprovedPct":10.6,"extendedRequests":null,"extendedApproved":0,"extendedApprovedPct":0,"expRequests":585,"expApproved":560,"expDenied":25,"expApprovedPct":95.73,"expDeniedPct":4.27,"stdAvgHours":26.4,"stdMedianHours":0,"expAvgHours":8.9,"expMedianHours":4,"timesAsPosted":"standard 1.1 days mean, 0 days median; expedited 8.9 hours mean, 4 hours median","note":"Appeals: the file prints \"Number of appealed auths overturned\" and an \"Overturn rate\" but not the number of appeals; the overturn rate matches overturned / denied requests, so appealApprovedPct uses denied requests as denominator. Overturn rates are printed with two decimals but always end in 0 (e.g. \"8.10%\"); they match overturned/denied at one decimal. Expedited appeals overturned (not in schema): 1, overturn rate 4.00%. Extension figures come from a file-wide note, not this contract's row: \"Across all contracts, we had 0 requests approved following an extension, and therefore a 0% extension request overall approval rate.\" It covers standard and expedited; extension request counts are not printed. Times printed as bare numbers; units taken from column headers \"time (days)\" for standard and \"time (hours)\" for expedited. No plan name printed; contract id only. The overturn rate is out of denied requests, not appeals, so it is left out of the market summary.","notPooled":["appealApprovedPct"]},{"id":"devoted-ma-h2526","year":2025,"payer":"Devoted Health","program":"ma","report":"H2526","part":null,"url":"https://assets.devoted.com/UM/2025/um-metrics","readOn":"2026-10-07","stdRequests":4462,"stdApproved":4359,"stdDenied":103,"stdApprovedPct":97.69,"stdDeniedPct":2.31,"appeals":null,"appealApproved":9,"appealApprovedPct":8.7,"extendedRequests":null,"extendedApproved":0,"extendedApprovedPct":0,"expRequests":268,"expApproved":251,"expDenied":17,"expApprovedPct":93.66,"expDeniedPct":6.34,"stdAvgHours":31.2,"stdMedianHours":0,"expAvgHours":18.6,"expMedianHours":3,"timesAsPosted":"standard 1.3 days mean, 0 days median; expedited 18.6 hours mean, 3 hours median","note":"Appeals: the file prints \"Number of appealed auths overturned\" and an \"Overturn rate\" but not the number of appeals; the overturn rate matches overturned / denied requests, so appealApprovedPct uses denied requests as denominator. Overturn rates are printed with two decimals but always end in 0 (e.g. \"8.10%\"); they match overturned/denied at one decimal. Expedited appeals overturned (not in schema): 3, overturn rate 17.60%. Extension figures come from a file-wide note, not this contract's row: \"Across all contracts, we had 0 requests approved following an extension, and therefore a 0% extension request overall approval rate.\" It covers standard and expedited; extension request counts are not printed. Times printed as bare numbers; units taken from column headers \"time (days)\" for standard and \"time (hours)\" for expedited. No plan name printed; contract id only. The overturn rate is out of denied requests, not appeals, so it is left out of the market summary.","notPooled":["appealApprovedPct"]},{"id":"devoted-ma-h2041","year":2025,"payer":"Devoted Health","program":"ma","report":"H2041","part":null,"url":"https://assets.devoted.com/UM/2025/um-metrics","readOn":"2026-10-07","stdRequests":3121,"stdApproved":2932,"stdDenied":189,"stdApprovedPct":93.94,"stdDeniedPct":6.06,"appeals":null,"appealApproved":12,"appealApprovedPct":6.3,"extendedRequests":null,"extendedApproved":0,"extendedApprovedPct":0,"expRequests":288,"expApproved":255,"expDenied":33,"expApprovedPct":88.54,"expDeniedPct":11.46,"stdAvgHours":31.2,"stdMedianHours":4.8,"expAvgHours":10.2,"expMedianHours":3,"timesAsPosted":"standard 1.3 days mean, 0.2 days median; expedited 10.2 hours mean, 3 hours median","note":"Appeals: the file prints \"Number of appealed auths overturned\" and an \"Overturn rate\" but not the number of appeals; the overturn rate matches overturned / denied requests, so appealApprovedPct uses denied requests as denominator. Overturn rates are printed with two decimals but always end in 0 (e.g. \"8.10%\"); they match overturned/denied at one decimal. Expedited appeals overturned (not in schema): 3, overturn rate 9.10%. Extension figures come from a file-wide note, not this contract's row: \"Across all contracts, we had 0 requests approved following an extension, and therefore a 0% extension request overall approval rate.\" It covers standard and expedited; extension request counts are not printed. Times printed as bare numbers; units taken from column headers \"time (days)\" for standard and \"time (hours)\" for expedited. No plan name printed; contract id only. The overturn rate is out of denied requests, not appeals, so it is left out of the market summary.","notPooled":["appealApprovedPct"]},{"id":"devoted-ma-h6586","year":2025,"payer":"Devoted Health","program":"ma","report":"H6586","part":null,"url":"https://assets.devoted.com/UM/2025/um-metrics","readOn":"2026-10-07","stdRequests":2939,"stdApproved":2874,"stdDenied":65,"stdApprovedPct":97.79,"stdDeniedPct":2.21,"appeals":null,"appealApproved":7,"appealApprovedPct":10.8,"extendedRequests":null,"extendedApproved":0,"extendedApprovedPct":0,"expRequests":547,"expApproved":528,"expDenied":19,"expApprovedPct":96.53,"expDeniedPct":3.47,"stdAvgHours":26.4,"stdMedianHours":0,"expAvgHours":6.6,"expMedianHours":2,"timesAsPosted":"standard 1.1 days mean, 0 days median; expedited 6.6 hours mean, 2 hours median","note":"Appeals: the file prints \"Number of appealed auths overturned\" and an \"Overturn rate\" but not the number of appeals; the overturn rate matches overturned / denied requests, so appealApprovedPct uses denied requests as denominator. Overturn rates are printed with two decimals but always end in 0 (e.g. \"8.10%\"); they match overturned/denied at one decimal. Expedited appeals overturned (not in schema): 2, overturn rate 10.50%. Extension figures come from a file-wide note, not this contract's row: \"Across all contracts, we had 0 requests approved following an extension, and therefore a 0% extension request overall approval rate.\" It covers standard and expedited; extension request counts are not printed. Times printed as bare numbers; units taken from column headers \"time (days)\" for standard and \"time (hours)\" for expedited. No plan name printed; contract id only. The overturn rate is out of denied requests, not appeals, so it is left out of the market summary.","notPooled":["appealApprovedPct"]},{"id":"devoted-ma-h2686","year":2025,"payer":"Devoted Health","program":"ma","report":"H2686","part":null,"url":"https://assets.devoted.com/UM/2025/um-metrics","readOn":"2026-10-07","stdRequests":2885,"stdApproved":2814,"stdDenied":71,"stdApprovedPct":97.54,"stdDeniedPct":2.46,"appeals":null,"appealApproved":7,"appealApprovedPct":9.9,"extendedRequests":null,"extendedApproved":0,"extendedApprovedPct":0,"expRequests":873,"expApproved":838,"expDenied":35,"expApprovedPct":95.99,"expDeniedPct":4.01,"stdAvgHours":28.8,"stdMedianHours":4.8,"expAvgHours":12.1,"expMedianHours":11,"timesAsPosted":"standard 1.2 days mean, 0.2 days median; expedited 12.1 hours mean, 11 hours median","note":"Appeals: the file prints \"Number of appealed auths overturned\" and an \"Overturn rate\" but not the number of appeals; the overturn rate matches overturned / denied requests, so appealApprovedPct uses denied requests as denominator. Overturn rates are printed with two decimals but always end in 0 (e.g. \"8.10%\"); they match overturned/denied at one decimal. Expedited appeals overturned (not in schema): 5, overturn rate 14.30%. Extension figures come from a file-wide note, not this contract's row: \"Across all contracts, we had 0 requests approved following an extension, and therefore a 0% extension request overall approval rate.\" It covers standard and expedited; extension request counts are not printed. Times printed as bare numbers; units taken from column headers \"time (days)\" for standard and \"time (hours)\" for expedited. No plan name printed; contract id only. The overturn rate is out of denied requests, not appeals, so it is left out of the market summary.","notPooled":["appealApprovedPct"]},{"id":"devoted-ma-h9700","year":2025,"payer":"Devoted Health","program":"ma","report":"H9700","part":null,"url":"https://assets.devoted.com/UM/2025/um-metrics","readOn":"2026-10-07","stdRequests":2864,"stdApproved":2806,"stdDenied":58,"stdApprovedPct":97.97,"stdDeniedPct":2.03,"appeals":null,"appealApproved":9,"appealApprovedPct":15.5,"extendedRequests":null,"extendedApproved":0,"extendedApprovedPct":0,"expRequests":366,"expApproved":353,"expDenied":13,"expApprovedPct":96.45,"expDeniedPct":3.55,"stdAvgHours":28.8,"stdMedianHours":2.4,"expAvgHours":5.4,"expMedianHours":1,"timesAsPosted":"standard 1.2 days mean, 0.1 days median; expedited 5.4 hours mean, 1 hour median","note":"Appeals: the file prints \"Number of appealed auths overturned\" and an \"Overturn rate\" but not the number of appeals; the overturn rate matches overturned / denied requests, so appealApprovedPct uses denied requests as denominator. Overturn rates are printed with two decimals but always end in 0 (e.g. \"8.10%\"); they match overturned/denied at one decimal. Expedited appeals overturned (not in schema): 2, overturn rate 15.40%. Extension figures come from a file-wide note, not this contract's row: \"Across all contracts, we had 0 requests approved following an extension, and therefore a 0% extension request overall approval rate.\" It covers standard and expedited; extension request counts are not printed. Times printed as bare numbers; units taken from column headers \"time (days)\" for standard and \"time (hours)\" for expedited. No plan name printed; contract id only. The overturn rate is out of denied requests, not appeals, so it is left out of the market summary.","notPooled":["appealApprovedPct"]},{"id":"devoted-ma-h9888","year":2025,"payer":"Devoted Health","program":"ma","report":"H9888","part":null,"url":"https://assets.devoted.com/UM/2025/um-metrics","readOn":"2026-10-07","stdRequests":2812,"stdApproved":2728,"stdDenied":84,"stdApprovedPct":97.01,"stdDeniedPct":2.99,"appeals":null,"appealApproved":7,"appealApprovedPct":8.3,"extendedRequests":null,"extendedApproved":0,"extendedApprovedPct":0,"expRequests":326,"expApproved":314,"expDenied":12,"expApprovedPct":96.32,"expDeniedPct":3.68,"stdAvgHours":26.4,"stdMedianHours":0,"expAvgHours":7.6,"expMedianHours":2,"timesAsPosted":"standard 1.1 days mean, 0 days median; expedited 7.6 hours mean, 2 hours median","note":"Appeals: the file prints \"Number of appealed auths overturned\" and an \"Overturn rate\" but not the number of appeals; the overturn rate matches overturned / denied requests, so appealApprovedPct uses denied requests as denominator. Overturn rates are printed with two decimals but always end in 0 (e.g. \"8.10%\"); they match overturned/denied at one decimal. Expedited appeals overturned (not in schema): 2, overturn rate 16.70%. Extension figures come from a file-wide note, not this contract's row: \"Across all contracts, we had 0 requests approved following an extension, and therefore a 0% extension request overall approval rate.\" It covers standard and expedited; extension request counts are not printed. Times printed as bare numbers; units taken from column headers \"time (days)\" for standard and \"time (hours)\" for expedited. No plan name printed; contract id only. The overturn rate is out of denied requests, not appeals, so it is left out of the market summary.","notPooled":["appealApprovedPct"]},{"id":"devoted-ma-h5299","year":2025,"payer":"Devoted Health","program":"ma","report":"H5299","part":null,"url":"https://assets.devoted.com/UM/2025/um-metrics","readOn":"2026-10-07","stdRequests":2673,"stdApproved":2534,"stdDenied":139,"stdApprovedPct":94.8,"stdDeniedPct":5.2,"appeals":null,"appealApproved":10,"appealApprovedPct":7.2,"extendedRequests":null,"extendedApproved":0,"extendedApprovedPct":0,"expRequests":292,"expApproved":269,"expDenied":23,"expApprovedPct":92.12,"expDeniedPct":7.88,"stdAvgHours":31.2,"stdMedianHours":2.4,"expAvgHours":7.9,"expMedianHours":2,"timesAsPosted":"standard 1.3 days mean, 0.1 days median; expedited 7.9 hours mean, 2 hours median","note":"Appeals: the file prints \"Number of appealed auths overturned\" and an \"Overturn rate\" but not the number of appeals; the overturn rate matches overturned / denied requests, so appealApprovedPct uses denied requests as denominator. Overturn rates are printed with two decimals but always end in 0 (e.g. \"8.10%\"); they match overturned/denied at one decimal. Expedited appeals overturned (not in schema): 5, overturn rate 21.70%. Extension figures come from a file-wide note, not this contract's row: \"Across all contracts, we had 0 requests approved following an extension, and therefore a 0% extension request overall approval rate.\" It covers standard and expedited; extension request counts are not printed. Times printed as bare numbers; units taken from column headers \"time (days)\" for standard and \"time (hours)\" for expedited. No plan name printed; contract id only. The overturn rate is out of denied requests, not appeals, so it is left out of the market summary.","notPooled":["appealApprovedPct"]},{"id":"devoted-ma-h5453","year":2025,"payer":"Devoted Health","program":"ma","report":"H5453","part":null,"url":"https://assets.devoted.com/UM/2025/um-metrics","readOn":"2026-10-07","stdRequests":2418,"stdApproved":2369,"stdDenied":49,"stdApprovedPct":97.97,"stdDeniedPct":2.03,"appeals":null,"appealApproved":3,"appealApprovedPct":6.1,"extendedRequests":null,"extendedApproved":0,"extendedApprovedPct":0,"expRequests":396,"expApproved":377,"expDenied":19,"expApprovedPct":95.2,"expDeniedPct":4.8,"stdAvgHours":33.6,"stdMedianHours":2.4,"expAvgHours":6.2,"expMedianHours":2,"timesAsPosted":"standard 1.4 days mean, 0.1 days median; expedited 6.2 hours mean, 2 hours median","note":"Appeals: the file prints \"Number of appealed auths overturned\" and an \"Overturn rate\" but not the number of appeals; the overturn rate matches overturned / denied requests, so appealApprovedPct uses denied requests as denominator. Overturn rates are printed with two decimals but always end in 0 (e.g. \"8.10%\"); they match overturned/denied at one decimal. Expedited appeals overturned (not in schema): 5, overturn rate 26.30%. Extension figures come from a file-wide note, not this contract's row: \"Across all contracts, we had 0 requests approved following an extension, and therefore a 0% extension request overall approval rate.\" It covers standard and expedited; extension request counts are not printed. Times printed as bare numbers; units taken from column headers \"time (days)\" for standard and \"time (hours)\" for expedited. No plan name printed; contract id only. The overturn rate is out of denied requests, not appeals, so it is left out of the market summary.","notPooled":["appealApprovedPct"]},{"id":"devoted-ma-h7151","year":2025,"payer":"Devoted Health","program":"ma","report":"H7151","part":null,"url":"https://assets.devoted.com/UM/2025/um-metrics","readOn":"2026-10-07","stdRequests":2408,"stdApproved":2216,"stdDenied":192,"stdApprovedPct":92.03,"stdDeniedPct":7.97,"appeals":null,"appealApproved":6,"appealApprovedPct":3.1,"extendedRequests":null,"extendedApproved":0,"extendedApprovedPct":0,"expRequests":204,"expApproved":168,"expDenied":36,"expApprovedPct":82.35,"expDeniedPct":17.65,"stdAvgHours":38.4,"stdMedianHours":4.8,"expAvgHours":11.3,"expMedianHours":4,"timesAsPosted":"standard 1.6 days mean, 0.2 days median; expedited 11.3 hours mean, 4 hours median","note":"Appeals: the file prints \"Number of appealed auths overturned\" and an \"Overturn rate\" but not the number of appeals; the overturn rate matches overturned / denied requests, so appealApprovedPct uses denied requests as denominator. Overturn rates are printed with two decimals but always end in 0 (e.g. \"8.10%\"); they match overturned/denied at one decimal. Expedited appeals overturned (not in schema): 6, overturn rate 16.70%. Extension figures come from a file-wide note, not this contract's row: \"Across all contracts, we had 0 requests approved following an extension, and therefore a 0% extension request overall approval rate.\" It covers standard and expedited; extension request counts are not printed. Times printed as bare numbers; units taken from column headers \"time (days)\" for standard and \"time (hours)\" for expedited. No plan name printed; contract id only. The overturn rate is out of denied requests, not appeals, so it is left out of the market summary.","notPooled":["appealApprovedPct"]},{"id":"devoted-ma-h6018","year":2025,"payer":"Devoted Health","program":"ma","report":"H6018","part":null,"url":"https://assets.devoted.com/UM/2025/um-metrics","readOn":"2026-10-07","stdRequests":2393,"stdApproved":2341,"stdDenied":52,"stdApprovedPct":97.83,"stdDeniedPct":2.17,"appeals":null,"appealApproved":6,"appealApprovedPct":11.5,"extendedRequests":null,"extendedApproved":0,"extendedApprovedPct":0,"expRequests":342,"expApproved":325,"expDenied":17,"expApprovedPct":95.03,"expDeniedPct":4.97,"stdAvgHours":26.4,"stdMedianHours":0,"expAvgHours":8.9,"expMedianHours":2,"timesAsPosted":"standard 1.1 days mean, 0 days median; expedited 8.9 hours mean, 2 hours median","note":"Appeals: the file prints \"Number of appealed auths overturned\" and an \"Overturn rate\" but not the number of appeals; the overturn rate matches overturned / denied requests, so appealApprovedPct uses denied requests as denominator. Overturn rates are printed with two decimals but always end in 0 (e.g. \"8.10%\"); they match overturned/denied at one decimal. Expedited appeals overturned (not in schema): 3, overturn rate 17.60%. Extension figures come from a file-wide note, not this contract's row: \"Across all contracts, we had 0 requests approved following an extension, and therefore a 0% extension request overall approval rate.\" It covers standard and expedited; extension request counts are not printed. Times printed as bare numbers; units taken from column headers \"time (days)\" for standard and \"time (hours)\" for expedited. No plan name printed; contract id only. The overturn rate is out of denied requests, not appeals, so it is left out of the market summary.","notPooled":["appealApprovedPct"]},{"id":"devoted-ma-h9231","year":2025,"payer":"Devoted Health","program":"ma","report":"H9231","part":null,"url":"https://assets.devoted.com/UM/2025/um-metrics","readOn":"2026-10-07","stdRequests":1939,"stdApproved":1876,"stdDenied":63,"stdApprovedPct":96.75,"stdDeniedPct":3.25,"appeals":null,"appealApproved":8,"appealApprovedPct":12.7,"extendedRequests":null,"extendedApproved":0,"extendedApprovedPct":0,"expRequests":296,"expApproved":270,"expDenied":26,"expApprovedPct":91.22,"expDeniedPct":8.78,"stdAvgHours":31.2,"stdMedianHours":2.4,"expAvgHours":9.7,"expMedianHours":2,"timesAsPosted":"standard 1.3 days mean, 0.1 days median; expedited 9.7 hours mean, 2 hours median","note":"Appeals: the file prints \"Number of appealed auths overturned\" and an \"Overturn rate\" but not the number of appeals; the overturn rate matches overturned / denied requests, so appealApprovedPct uses denied requests as denominator. Overturn rates are printed with two decimals but always end in 0 (e.g. \"8.10%\"); they match overturned/denied at one decimal. Expedited appeals overturned (not in schema): 2, overturn rate 7.70%. Extension figures come from a file-wide note, not this contract's row: \"Across all contracts, we had 0 requests approved following an extension, and therefore a 0% extension request overall approval rate.\" It covers standard and expedited; extension request counts are not printed. Times printed as bare numbers; units taken from column headers \"time (days)\" for standard and \"time (hours)\" for expedited. No plan name printed; contract id only. The overturn rate is out of denied requests, not appeals, so it is left out of the market summary.","notPooled":["appealApprovedPct"]},{"id":"devoted-ma-h7605","year":2025,"payer":"Devoted Health","program":"ma","report":"H7605","part":null,"url":"https://assets.devoted.com/UM/2025/um-metrics","readOn":"2026-10-07","stdRequests":1700,"stdApproved":1546,"stdDenied":154,"stdApprovedPct":90.94,"stdDeniedPct":9.06,"appeals":null,"appealApproved":5,"appealApprovedPct":3.2,"extendedRequests":null,"extendedApproved":0,"extendedApprovedPct":0,"expRequests":186,"expApproved":162,"expDenied":24,"expApprovedPct":87.1,"expDeniedPct":12.9,"stdAvgHours":43.2,"stdMedianHours":21.6,"expAvgHours":10.9,"expMedianHours":3,"timesAsPosted":"standard 1.8 days mean, 0.9 days median; expedited 10.9 hours mean, 3 hours median","note":"Appeals: the file prints \"Number of appealed auths overturned\" and an \"Overturn rate\" but not the number of appeals; the overturn rate matches overturned / denied requests, so appealApprovedPct uses denied requests as denominator. Overturn rates are printed with two decimals but always end in 0 (e.g. \"8.10%\"); they match overturned/denied at one decimal. Expedited appeals overturned (not in schema): 0, overturn rate 0.00%. Extension figures come from a file-wide note, not this contract's row: \"Across all contracts, we had 0 requests approved following an extension, and therefore a 0% extension request overall approval rate.\" It covers standard and expedited; extension request counts are not printed. Times printed as bare numbers; units taken from column headers \"time (days)\" for standard and \"time (hours)\" for expedited. No plan name printed; contract id only. The overturn rate is out of denied requests, not appeals, so it is left out of the market summary.","notPooled":["appealApprovedPct"]},{"id":"devoted-ma-h7199","year":2025,"payer":"Devoted Health","program":"ma","report":"H7199","part":null,"url":"https://assets.devoted.com/UM/2025/um-metrics","readOn":"2026-10-07","stdRequests":1634,"stdApproved":1603,"stdDenied":31,"stdApprovedPct":98.1,"stdDeniedPct":1.9,"appeals":null,"appealApproved":3,"appealApprovedPct":9.7,"extendedRequests":null,"extendedApproved":0,"extendedApprovedPct":0,"expRequests":234,"expApproved":229,"expDenied":5,"expApprovedPct":97.86,"expDeniedPct":2.14,"stdAvgHours":28.8,"stdMedianHours":0,"expAvgHours":8.8,"expMedianHours":3,"timesAsPosted":"standard 1.2 days mean, 0 days median; expedited 8.8 hours mean, 3 hours median","note":"Appeals: the file prints \"Number of appealed auths overturned\" and an \"Overturn rate\" but not the number of appeals; the overturn rate matches overturned / denied requests, so appealApprovedPct uses denied requests as denominator. Overturn rates are printed with two decimals but always end in 0 (e.g. \"8.10%\"); they match overturned/denied at one decimal. Expedited appeals overturned (not in schema): 1, overturn rate 20.00%. Extension figures come from a file-wide note, not this contract's row: \"Across all contracts, we had 0 requests approved following an extension, and therefore a 0% extension request overall approval rate.\" It covers standard and expedited; extension request counts are not printed. Times printed as bare numbers; units taken from column headers \"time (days)\" for standard and \"time (hours)\" for expedited. No plan name printed; contract id only. The overturn rate is out of denied requests, not appeals, so it is left out of the market summary.","notPooled":["appealApprovedPct"]},{"id":"devoted-ma-h7355","year":2025,"payer":"Devoted Health","program":"ma","report":"H7355","part":null,"url":"https://assets.devoted.com/UM/2025/um-metrics","readOn":"2026-10-07","stdRequests":1573,"stdApproved":1516,"stdDenied":57,"stdApprovedPct":96.38,"stdDeniedPct":3.62,"appeals":null,"appealApproved":0,"appealApprovedPct":0,"extendedRequests":null,"extendedApproved":0,"extendedApprovedPct":0,"expRequests":143,"expApproved":135,"expDenied":8,"expApprovedPct":94.41,"expDeniedPct":5.59,"stdAvgHours":31.2,"stdMedianHours":4.8,"expAvgHours":7.6,"expMedianHours":2,"timesAsPosted":"standard 1.3 days mean, 0.2 days median; expedited 7.6 hours mean, 2 hours median","note":"Appeals: the file prints \"Number of appealed auths overturned\" and an \"Overturn rate\" but not the number of appeals; the overturn rate matches overturned / denied requests, so appealApprovedPct uses denied requests as denominator. Overturn rates are printed with two decimals but always end in 0 (e.g. \"8.10%\"); they match overturned/denied at one decimal. Expedited appeals overturned (not in schema): 1, overturn rate 12.50%. Extension figures come from a file-wide note, not this contract's row: \"Across all contracts, we had 0 requests approved following an extension, and therefore a 0% extension request overall approval rate.\" It covers standard and expedited; extension request counts are not printed. Times printed as bare numbers; units taken from column headers \"time (days)\" for standard and \"time (hours)\" for expedited. No plan name printed; contract id only. The overturn rate is out of denied requests, not appeals, so it is left out of the market summary.","notPooled":["appealApprovedPct"]},{"id":"devoted-ma-h2923","year":2025,"payer":"Devoted Health","program":"ma","report":"H2923","part":null,"url":"https://assets.devoted.com/UM/2025/um-metrics","readOn":"2026-10-07","stdRequests":1505,"stdApproved":1395,"stdDenied":110,"stdApprovedPct":92.69,"stdDeniedPct":7.31,"appeals":null,"appealApproved":5,"appealApprovedPct":4.5,"extendedRequests":null,"extendedApproved":0,"extendedApprovedPct":0,"expRequests":239,"expApproved":207,"expDenied":32,"expApprovedPct":86.61,"expDeniedPct":13.39,"stdAvgHours":36,"stdMedianHours":4.8,"expAvgHours":10.5,"expMedianHours":4,"timesAsPosted":"standard 1.5 days mean, 0.2 days median; expedited 10.5 hours mean, 4 hours median","note":"Appeals: the file prints \"Number of appealed auths overturned\" and an \"Overturn rate\" but not the number of appeals; the overturn rate matches overturned / denied requests, so appealApprovedPct uses denied requests as denominator. Overturn rates are printed with two decimals but always end in 0 (e.g. \"8.10%\"); they match overturned/denied at one decimal. Expedited appeals overturned (not in schema): 3, overturn rate 9.40%. Extension figures come from a file-wide note, not this contract's row: \"Across all contracts, we had 0 requests approved following an extension, and therefore a 0% extension request overall approval rate.\" It covers standard and expedited; extension request counts are not printed. Times printed as bare numbers; units taken from column headers \"time (days)\" for standard and \"time (hours)\" for expedited. No plan name printed; contract id only. The overturn rate is out of denied requests, not appeals, so it is left out of the market summary.","notPooled":["appealApprovedPct"]},{"id":"devoted-ma-h6813","year":2025,"payer":"Devoted Health","program":"ma","report":"H6813","part":null,"url":"https://assets.devoted.com/UM/2025/um-metrics","readOn":"2026-10-07","stdRequests":1470,"stdApproved":1369,"stdDenied":101,"stdApprovedPct":93.13,"stdDeniedPct":6.87,"appeals":null,"appealApproved":6,"appealApprovedPct":5.9,"extendedRequests":null,"extendedApproved":0,"extendedApprovedPct":0,"expRequests":239,"expApproved":228,"expDenied":11,"expApprovedPct":95.4,"expDeniedPct":4.6,"stdAvgHours":31.2,"stdMedianHours":2.4,"expAvgHours":6.6,"expMedianHours":1,"timesAsPosted":"standard 1.3 days mean, 0.1 days median; expedited 6.6 hours mean, 1 hour median","note":"Appeals: the file prints \"Number of appealed auths overturned\" and an \"Overturn rate\" but not the number of appeals; the overturn rate matches overturned / denied requests, so appealApprovedPct uses denied requests as denominator. Overturn rates are printed with two decimals but always end in 0 (e.g. \"8.10%\"); they match overturned/denied at one decimal. Expedited appeals overturned (not in schema): 2, overturn rate 18.20%. Extension figures come from a file-wide note, not this contract's row: \"Across all contracts, we had 0 requests approved following an extension, and therefore a 0% extension request overall approval rate.\" It covers standard and expedited; extension request counts are not printed. Times printed as bare numbers; units taken from column headers \"time (days)\" for standard and \"time (hours)\" for expedited. No plan name printed; contract id only. The overturn rate is out of denied requests, not appeals, so it is left out of the market summary.","notPooled":["appealApprovedPct"]},{"id":"devoted-ma-h5718","year":2025,"payer":"Devoted Health","program":"ma","report":"H5718","part":null,"url":"https://assets.devoted.com/UM/2025/um-metrics","readOn":"2026-10-07","stdRequests":1389,"stdApproved":1340,"stdDenied":49,"stdApprovedPct":96.47,"stdDeniedPct":3.53,"appeals":null,"appealApproved":7,"appealApprovedPct":14.3,"extendedRequests":null,"extendedApproved":0,"extendedApprovedPct":0,"expRequests":192,"expApproved":177,"expDenied":15,"expApprovedPct":92.19,"expDeniedPct":7.81,"stdAvgHours":26.4,"stdMedianHours":2.4,"expAvgHours":7.7,"expMedianHours":2,"timesAsPosted":"standard 1.1 days mean, 0.1 days median; expedited 7.7 hours mean, 2 hours median","note":"Appeals: the file prints \"Number of appealed auths overturned\" and an \"Overturn rate\" but not the number of appeals; the overturn rate matches overturned / denied requests, so appealApprovedPct uses denied requests as denominator. Overturn rates are printed with two decimals but always end in 0 (e.g. \"8.10%\"); they match overturned/denied at one decimal. Expedited appeals overturned (not in schema): 0, overturn rate 0.00%. Extension figures come from a file-wide note, not this contract's row: \"Across all contracts, we had 0 requests approved following an extension, and therefore a 0% extension request overall approval rate.\" It covers standard and expedited; extension request counts are not printed. Times printed as bare numbers; units taken from column headers \"time (days)\" for standard and \"time (hours)\" for expedited. No plan name printed; contract id only. The overturn rate is out of denied requests, not appeals, so it is left out of the market summary.","notPooled":["appealApprovedPct"]},{"id":"devoted-ma-h9884","year":2025,"payer":"Devoted Health","program":"ma","report":"H9884","part":null,"url":"https://assets.devoted.com/UM/2025/um-metrics","readOn":"2026-10-07","stdRequests":1364,"stdApproved":1325,"stdDenied":39,"stdApprovedPct":97.14,"stdDeniedPct":2.86,"appeals":null,"appealApproved":3,"appealApprovedPct":7.7,"extendedRequests":null,"extendedApproved":0,"extendedApprovedPct":0,"expRequests":163,"expApproved":148,"expDenied":15,"expApprovedPct":90.8,"expDeniedPct":9.2,"stdAvgHours":38.4,"stdMedianHours":0,"expAvgHours":8.7,"expMedianHours":2,"timesAsPosted":"standard 1.6 days mean, 0 days median; expedited 8.7 hours mean, 2 hours median","note":"Appeals: the file prints \"Number of appealed auths overturned\" and an \"Overturn rate\" but not the number of appeals; the overturn rate matches overturned / denied requests, so appealApprovedPct uses denied requests as denominator. Overturn rates are printed with two decimals but always end in 0 (e.g. \"8.10%\"); they match overturned/denied at one decimal. Expedited appeals overturned (not in schema): 3, overturn rate 20.00%. Extension figures come from a file-wide note, not this contract's row: \"Across all contracts, we had 0 requests approved following an extension, and therefore a 0% extension request overall approval rate.\" It covers standard and expedited; extension request counts are not printed. Times printed as bare numbers; units taken from column headers \"time (days)\" for standard and \"time (hours)\" for expedited. No plan name printed; contract id only. The overturn rate is out of denied requests, not appeals, so it is left out of the market summary.","notPooled":["appealApprovedPct"]},{"id":"devoted-ma-h6545","year":2025,"payer":"Devoted Health","program":"ma","report":"H6545","part":null,"url":"https://assets.devoted.com/UM/2025/um-metrics","readOn":"2026-10-07","stdRequests":1330,"stdApproved":1283,"stdDenied":47,"stdApprovedPct":96.47,"stdDeniedPct":3.53,"appeals":null,"appealApproved":7,"appealApprovedPct":14.9,"extendedRequests":null,"extendedApproved":0,"extendedApprovedPct":0,"expRequests":186,"expApproved":175,"expDenied":11,"expApprovedPct":94.09,"expDeniedPct":5.91,"stdAvgHours":26.4,"stdMedianHours":0,"expAvgHours":7.6,"expMedianHours":1,"timesAsPosted":"standard 1.1 days mean, 0 days median; expedited 7.6 hours mean, 1 hour median","note":"Appeals: the file prints \"Number of appealed auths overturned\" and an \"Overturn rate\" but not the number of appeals; the overturn rate matches overturned / denied requests, so appealApprovedPct uses denied requests as denominator. Overturn rates are printed with two decimals but always end in 0 (e.g. \"8.10%\"); they match overturned/denied at one decimal. Expedited appeals overturned (not in schema): 1, overturn rate 9.10%. Extension figures come from a file-wide note, not this contract's row: \"Across all contracts, we had 0 requests approved following an extension, and therefore a 0% extension request overall approval rate.\" It covers standard and expedited; extension request counts are not printed. Times printed as bare numbers; units taken from column headers \"time (days)\" for standard and \"time (hours)\" for expedited. No plan name printed; contract id only. The overturn rate is out of denied requests, not appeals, so it is left out of the market summary.","notPooled":["appealApprovedPct"]},{"id":"devoted-ma-h6852","year":2025,"payer":"Devoted Health","program":"ma","report":"H6852","part":null,"url":"https://assets.devoted.com/UM/2025/um-metrics","readOn":"2026-10-07","stdRequests":1217,"stdApproved":1110,"stdDenied":107,"stdApprovedPct":91.21,"stdDeniedPct":8.79,"appeals":null,"appealApproved":4,"appealApprovedPct":3.7,"extendedRequests":null,"extendedApproved":0,"extendedApprovedPct":0,"expRequests":258,"expApproved":200,"expDenied":58,"expApprovedPct":77.52,"expDeniedPct":22.48,"stdAvgHours":36,"stdMedianHours":4.8,"expAvgHours":10.7,"expMedianHours":4,"timesAsPosted":"standard 1.5 days mean, 0.2 days median; expedited 10.7 hours mean, 4 hours median","note":"Appeals: the file prints \"Number of appealed auths overturned\" and an \"Overturn rate\" but not the number of appeals; the overturn rate matches overturned / denied requests, so appealApprovedPct uses denied requests as denominator. Overturn rates are printed with two decimals but always end in 0 (e.g. \"8.10%\"); they match overturned/denied at one decimal. Expedited appeals overturned (not in schema): 6, overturn rate 10.30%. Extension figures come from a file-wide note, not this contract's row: \"Across all contracts, we had 0 requests approved following an extension, and therefore a 0% extension request overall approval rate.\" It covers standard and expedited; extension request counts are not printed. Times printed as bare numbers; units taken from column headers \"time (days)\" for standard and \"time (hours)\" for expedited. No plan name printed; contract id only. The overturn rate is out of denied requests, not appeals, so it is left out of the market summary.","notPooled":["appealApprovedPct"]},{"id":"devoted-ma-h3041","year":2025,"payer":"Devoted Health","program":"ma","report":"H3041","part":null,"url":"https://assets.devoted.com/UM/2025/um-metrics","readOn":"2026-10-07","stdRequests":1198,"stdApproved":1147,"stdDenied":51,"stdApprovedPct":95.74,"stdDeniedPct":4.26,"appeals":null,"appealApproved":2,"appealApprovedPct":3.9,"extendedRequests":null,"extendedApproved":0,"extendedApprovedPct":0,"expRequests":78,"expApproved":71,"expDenied":7,"expApprovedPct":91.03,"expDeniedPct":8.97,"stdAvgHours":28.8,"stdMedianHours":0,"expAvgHours":8.3,"expMedianHours":2.5,"timesAsPosted":"standard 1.2 days mean, 0 days median; expedited 8.3 hours mean, 2.5 hours median","note":"Appeals: the file prints \"Number of appealed auths overturned\" and an \"Overturn rate\" but not the number of appeals; the overturn rate matches overturned / denied requests, so appealApprovedPct uses denied requests as denominator. Overturn rates are printed with two decimals but always end in 0 (e.g. \"8.10%\"); they match overturned/denied at one decimal. Expedited appeals overturned (not in schema): 0, overturn rate 0.00%. Extension figures come from a file-wide note, not this contract's row: \"Across all contracts, we had 0 requests approved following an extension, and therefore a 0% extension request overall approval rate.\" It covers standard and expedited; extension request counts are not printed. Times printed as bare numbers; units taken from column headers \"time (days)\" for standard and \"time (hours)\" for expedited. No plan name printed; contract id only. The overturn rate is out of denied requests, not appeals, so it is left out of the market summary.","notPooled":["appealApprovedPct"]},{"id":"devoted-ma-h7471","year":2025,"payer":"Devoted Health","program":"ma","report":"H7471","part":null,"url":"https://assets.devoted.com/UM/2025/um-metrics","readOn":"2026-10-07","stdRequests":984,"stdApproved":950,"stdDenied":34,"stdApprovedPct":96.54,"stdDeniedPct":3.46,"appeals":null,"appealApproved":2,"appealApprovedPct":5.9,"extendedRequests":null,"extendedApproved":0,"extendedApprovedPct":0,"expRequests":143,"expApproved":136,"expDenied":7,"expApprovedPct":95.1,"expDeniedPct":4.9,"stdAvgHours":24,"stdMedianHours":2.4,"expAvgHours":5.3,"expMedianHours":1,"timesAsPosted":"standard 1 day mean, 0.1 days median; expedited 5.3 hours mean, 1 hour median","note":"Appeals: the file prints \"Number of appealed auths overturned\" and an \"Overturn rate\" but not the number of appeals; the overturn rate matches overturned / denied requests, so appealApprovedPct uses denied requests as denominator. Overturn rates are printed with two decimals but always end in 0 (e.g. \"8.10%\"); they match overturned/denied at one decimal. Expedited appeals overturned (not in schema): 0, overturn rate 0.00%. Extension figures come from a file-wide note, not this contract's row: \"Across all contracts, we had 0 requests approved following an extension, and therefore a 0% extension request overall approval rate.\" It covers standard and expedited; extension request counts are not printed. Times printed as bare numbers; units taken from column headers \"time (days)\" for standard and \"time (hours)\" for expedited. No plan name printed; contract id only. The overturn rate is out of denied requests, not appeals, so it is left out of the market summary.","notPooled":["appealApprovedPct"]},{"id":"devoted-ma-h8917","year":2025,"payer":"Devoted Health","program":"ma","report":"H8917","part":null,"url":"https://assets.devoted.com/UM/2025/um-metrics","readOn":"2026-10-07","stdRequests":844,"stdApproved":822,"stdDenied":22,"stdApprovedPct":97.39,"stdDeniedPct":2.61,"appeals":null,"appealApproved":2,"appealApprovedPct":9.1,"extendedRequests":null,"extendedApproved":0,"extendedApprovedPct":0,"expRequests":119,"expApproved":115,"expDenied":4,"expApprovedPct":96.64,"expDeniedPct":3.36,"stdAvgHours":24,"stdMedianHours":0,"expAvgHours":6.8,"expMedianHours":2,"timesAsPosted":"standard 1 day mean, 0 days median; expedited 6.8 hours mean, 2 hours median","note":"Appeals: the file prints \"Number of appealed auths overturned\" and an \"Overturn rate\" but not the number of appeals; the overturn rate matches overturned / denied requests, so appealApprovedPct uses denied requests as denominator. Overturn rates are printed with two decimals but always end in 0 (e.g. \"8.10%\"); they match overturned/denied at one decimal. Expedited appeals overturned (not in schema): 1, overturn rate 25.00%. Extension figures come from a file-wide note, not this contract's row: \"Across all contracts, we had 0 requests approved following an extension, and therefore a 0% extension request overall approval rate.\" It covers standard and expedited; extension request counts are not printed. Times printed as bare numbers; units taken from column headers \"time (days)\" for standard and \"time (hours)\" for expedited. No plan name printed; contract id only. The overturn rate is out of denied requests, not appeals, so it is left out of the market summary.","notPooled":["appealApprovedPct"]},{"id":"devoted-ma-h7397","year":2025,"payer":"Devoted Health","program":"ma","report":"H7397","part":null,"url":"https://assets.devoted.com/UM/2025/um-metrics","readOn":"2026-10-07","stdRequests":592,"stdApproved":582,"stdDenied":10,"stdApprovedPct":98.31,"stdDeniedPct":1.69,"appeals":null,"appealApproved":1,"appealApprovedPct":10,"extendedRequests":null,"extendedApproved":0,"extendedApprovedPct":0,"expRequests":70,"expApproved":59,"expDenied":11,"expApprovedPct":84.29,"expDeniedPct":15.71,"stdAvgHours":28.8,"stdMedianHours":2.4,"expAvgHours":16.1,"expMedianHours":6.5,"timesAsPosted":"standard 1.2 days mean, 0.1 days median; expedited 16.1 hours mean, 6.5 hours median","note":"Appeals: the file prints \"Number of appealed auths overturned\" and an \"Overturn rate\" but not the number of appeals; the overturn rate matches overturned / denied requests, so appealApprovedPct uses denied requests as denominator. Overturn rates are printed with two decimals but always end in 0 (e.g. \"8.10%\"); they match overturned/denied at one decimal. Expedited appeals overturned (not in schema): 0, overturn rate 0.00%. Extension figures come from a file-wide note, not this contract's row: \"Across all contracts, we had 0 requests approved following an extension, and therefore a 0% extension request overall approval rate.\" It covers standard and expedited; extension request counts are not printed. Times printed as bare numbers; units taken from column headers \"time (days)\" for standard and \"time (hours)\" for expedited. No plan name printed; contract id only. The overturn rate is out of denied requests, not appeals, so it is left out of the market summary.","notPooled":["appealApprovedPct"]},{"id":"devoted-ma-h8320","year":2025,"payer":"Devoted Health","program":"ma","report":"H8320","part":null,"url":"https://assets.devoted.com/UM/2025/um-metrics","readOn":"2026-10-07","stdRequests":396,"stdApproved":385,"stdDenied":11,"stdApprovedPct":97.22,"stdDeniedPct":2.78,"appeals":null,"appealApproved":1,"appealApprovedPct":9.1,"extendedRequests":null,"extendedApproved":0,"extendedApprovedPct":0,"expRequests":49,"expApproved":48,"expDenied":1,"expApprovedPct":97.96,"expDeniedPct":2.04,"stdAvgHours":31.2,"stdMedianHours":2.4,"expAvgHours":8.8,"expMedianHours":1,"timesAsPosted":"standard 1.3 days mean, 0.1 days median; expedited 8.8 hours mean, 1 hour median","note":"Appeals: the file prints \"Number of appealed auths overturned\" and an \"Overturn rate\" but not the number of appeals; the overturn rate matches overturned / denied requests, so appealApprovedPct uses denied requests as denominator. Overturn rates are printed with two decimals but always end in 0 (e.g. \"8.10%\"); they match overturned/denied at one decimal. Expedited appeals overturned (not in schema): 0, overturn rate 0.00%. Extension figures come from a file-wide note, not this contract's row: \"Across all contracts, we had 0 requests approved following an extension, and therefore a 0% extension request overall approval rate.\" It covers standard and expedited; extension request counts are not printed. Times printed as bare numbers; units taken from column headers \"time (days)\" for standard and \"time (hours)\" for expedited. No plan name printed; contract id only. The overturn rate is out of denied requests, not appeals, so it is left out of the market summary.","notPooled":["appealApprovedPct"]},{"id":"highmark-ma-h3916","year":2025,"payer":"Highmark","program":"ma","report":"H3916","part":null,"url":"https://providers.highmark.com/content/dam/highmark/en/providerresourcecenter/pdfs/all/documents/pdfs/authorization/prior-authorization-metrics/prior-authorization-metrics.pdf","readOn":"2026-10-07","stdRequests":463352,"stdApproved":445280,"stdDenied":18072,"stdApprovedPct":96,"stdDeniedPct":4,"appeals":1333,"appealApproved":1039,"appealApprovedPct":78,"extendedRequests":39526,"extendedApproved":38884,"extendedApprovedPct":98,"expRequests":81341,"expApproved":74476,"expDenied":6865,"expApprovedPct":92,"expDeniedPct":8,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":"standard <1 day mean, <1 day median; expedited <1 day mean, <1 day median","note":"Percentages printed as whole numbers. No plan name printed; contract id only. Expedited extension (not in schema): approved 185 of 189 (98%). Expedited appeals (not in schema): approved 1890 of 2865 (66%).","ratePrecision":{"stdApprovedPct":0,"stdDeniedPct":0,"expApprovedPct":0,"expDeniedPct":0,"appealApprovedPct":0,"extendedApprovedPct":0}},{"id":"highmark-ma-h3384","year":2025,"payer":"Highmark","program":"ma","report":"H3384","part":null,"url":"https://providers.highmark.com/content/dam/highmark/en/providerresourcecenter/pdfs/all/documents/pdfs/authorization/prior-authorization-metrics/prior-authorization-metrics.pdf","readOn":"2026-10-07","stdRequests":39409,"stdApproved":38823,"stdDenied":586,"stdApprovedPct":99,"stdDeniedPct":1,"appeals":114,"appealApproved":95,"appealApprovedPct":83,"extendedRequests":42,"extendedApproved":40,"extendedApprovedPct":95,"expRequests":23397,"expApproved":21986,"expDenied":1411,"expApprovedPct":94,"expDeniedPct":6,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":"standard <1 day mean, <1 day median; expedited <1 day mean, <1 day median","note":"Percentages printed as whole numbers. No plan name printed; contract id only. Expedited figures (21986 approved / 1411 denied of 23397; extension 1 of 1; appeals 111 of 133) are printed identically for H3384, H3957 and H5106; expedited extension (1 of 1) and appeals (111 of 133) also repeat for H5526 -- likely a copy error in the file. The file omits the \"approved within 7 days\" and \"approved within 72 hours\" rows for this contract. Expedited extension (not in schema): approved 1 of 1 (100%). Expedited appeals (not in schema): approved 111 of 133 (83%). Because the same expedited block is printed for three contracts, its rates are left out of the market summary.","ratePrecision":{"stdApprovedPct":0,"stdDeniedPct":0,"appealApprovedPct":0,"extendedApprovedPct":0},"notPooled":["expApprovedPct","expDeniedPct"]},{"id":"highmark-ma-h3957","year":2025,"payer":"Highmark","program":"ma","report":"H3957","part":null,"url":"https://providers.highmark.com/content/dam/highmark/en/providerresourcecenter/pdfs/all/documents/pdfs/authorization/prior-authorization-metrics/prior-authorization-metrics.pdf","readOn":"2026-10-07","stdRequests":98307,"stdApproved":95070,"stdDenied":3237,"stdApprovedPct":97,"stdDeniedPct":3,"appeals":198,"appealApproved":151,"appealApprovedPct":76,"extendedRequests":4564,"extendedApproved":4484,"extendedApprovedPct":98,"expRequests":23397,"expApproved":21986,"expDenied":1411,"expApprovedPct":94,"expDeniedPct":6,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":"standard <1 day mean, <1 day median; expedited <1 day mean, <1 day median","note":"Percentages printed as whole numbers. No plan name printed; contract id only. Expedited figures (21986 approved / 1411 denied of 23397; extension 1 of 1; appeals 111 of 133) are printed identically for H3384, H3957 and H5106; expedited extension (1 of 1) and appeals (111 of 133) also repeat for H5526 -- likely a copy error in the file. Expedited extension (not in schema): approved 1 of 1 (100%). Expedited appeals (not in schema): approved 111 of 133 (83%). Because the same expedited block is printed for three contracts, its rates are left out of the market summary.","ratePrecision":{"stdApprovedPct":0,"stdDeniedPct":0,"appealApprovedPct":0,"extendedApprovedPct":0},"notPooled":["expApprovedPct","expDeniedPct"]},{"id":"highmark-ma-h5106","year":2025,"payer":"Highmark","program":"ma","report":"H5106","part":null,"url":"https://providers.highmark.com/content/dam/highmark/en/providerresourcecenter/pdfs/all/documents/pdfs/authorization/prior-authorization-metrics/prior-authorization-metrics.pdf","readOn":"2026-10-07","stdRequests":41018,"stdApproved":38901,"stdDenied":2117,"stdApprovedPct":95,"stdDeniedPct":5,"appeals":199,"appealApproved":167,"appealApprovedPct":84,"extendedRequests":2244,"extendedApproved":2189,"extendedApprovedPct":98,"expRequests":23397,"expApproved":21986,"expDenied":1411,"expApprovedPct":94,"expDeniedPct":6,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":"standard <1 day mean, <1 day median; expedited <1 day mean, <1 day median","note":"Percentages printed as whole numbers. No plan name printed; contract id only. Expedited figures (21986 approved / 1411 denied of 23397; extension 1 of 1; appeals 111 of 133) are printed identically for H3384, H3957 and H5106; expedited extension (1 of 1) and appeals (111 of 133) also repeat for H5526 -- likely a copy error in the file. Expedited extension (not in schema): approved 1 of 1 (100%). Expedited appeals (not in schema): approved 111 of 133 (83%). Because the same expedited block is printed for three contracts, its rates are left out of the market summary.","ratePrecision":{"stdApprovedPct":0,"stdDeniedPct":0,"appealApprovedPct":0,"extendedApprovedPct":0},"notPooled":["expApprovedPct","expDeniedPct"]},{"id":"highmark-ma-h5526","year":2025,"payer":"Highmark","program":"ma","report":"H5526","part":null,"url":"https://providers.highmark.com/content/dam/highmark/en/providerresourcecenter/pdfs/all/documents/pdfs/authorization/prior-authorization-metrics/prior-authorization-metrics.pdf","readOn":"2026-10-07","stdRequests":25925,"stdApproved":25551,"stdDenied":374,"stdApprovedPct":99,"stdDeniedPct":1,"appeals":90,"appealApproved":70,"appealApprovedPct":78,"extendedRequests":55,"extendedApproved":54,"extendedApprovedPct":98,"expRequests":10481,"expApproved":9737,"expDenied":744,"expApprovedPct":93,"expDeniedPct":7,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":"standard <1 day mean, <1 day median; expedited <1 day mean, <1 day median","note":"Percentages printed as whole numbers. No plan name printed; contract id only. Expedited figures (21986 approved / 1411 denied of 23397; extension 1 of 1; appeals 111 of 133) are printed identically for H3384, H3957 and H5106; expedited extension (1 of 1) and appeals (111 of 133) also repeat for H5526 -- likely a copy error in the file. Expedited extension (not in schema): approved 1 of 1 (100%). Expedited appeals (not in schema): approved 111 of 133 (83%).","ratePrecision":{"stdApprovedPct":0,"stdDeniedPct":0,"expApprovedPct":0,"expDeniedPct":0,"appealApprovedPct":0,"extendedApprovedPct":0}},{"id":"highmark-ma-h8166","year":2025,"payer":"Highmark","program":"ma","report":"H8166","part":null,"url":"https://providers.highmark.com/content/dam/highmark/en/providerresourcecenter/pdfs/all/documents/pdfs/authorization/prior-authorization-metrics/prior-authorization-metrics.pdf","readOn":"2026-10-07","stdRequests":27105,"stdApproved":25991,"stdDenied":1114,"stdApprovedPct":96,"stdDeniedPct":4,"appeals":129,"appealApproved":103,"appealApprovedPct":80,"extendedRequests":2153,"extendedApproved":2105,"extendedApprovedPct":98,"expRequests":7979,"expApproved":7390,"expDenied":589,"expApprovedPct":93,"expDeniedPct":7,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":"standard <1 day mean, <1 day median; expedited <1 day mean, <1 day median","note":"Percentages printed as whole numbers. No plan name printed; contract id only. Expedited extension (not in schema): \"approved ... 4 / 4 / 100%\" but \"denied ... 0 / 1 / 0%\" -- the two rows give different totals in the file. Expedited appeals (not in schema): approved 186 of 215 (87%).","ratePrecision":{"stdApprovedPct":0,"stdDeniedPct":0,"expApprovedPct":0,"expDeniedPct":0,"appealApprovedPct":0,"extendedApprovedPct":0}},{"id":"highmark-ma-h5932","year":2025,"payer":"Highmark","program":"ma","report":"H5932 (PA DSNP)","part":null,"url":"https://providers.highmark.com/content/dam/highmark/en/providerresourcecenter/pdfs/all/documents/pdfs/authorization/prior-authorization-metrics/prior-authorization-metrics.pdf","readOn":"2026-10-07","stdRequests":7010,"stdApproved":6152,"stdDenied":857,"stdApprovedPct":88,"stdDeniedPct":12,"appeals":440,"appealApproved":318,"appealApprovedPct":72,"extendedRequests":4,"extendedApproved":4,"extendedApprovedPct":100,"expRequests":11889,"expApproved":10887,"expDenied":1002,"expApprovedPct":92,"expDeniedPct":8,"stdAvgHours":113.76,"stdMedianHours":131.76,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":"standard 4.74 days mean, 5.49 days median; expedited <1 day mean, <1 day median","note":"Percentages printed as whole numbers. D-SNP contract (Pennsylvania). Standard approved 6152 + denied 857 = 7009, but total printed as 7010. Standard extension: approved 4 of 4 (100%), denied row prints 0 of 0 (0%). Expedited extension (not in schema): approved 38 of 42 (90%). Expedited appeals (not in schema): approved 266 of 345 (77%). Within-7-days / within-72-hours rows use approved or denied counts as their denominators.","ratePrecision":{"stdApprovedPct":0,"stdDeniedPct":0,"expApprovedPct":0,"expDeniedPct":0,"appealApprovedPct":0}},{"id":"highmark-ma-h7710","year":2025,"payer":"Highmark","program":"ma","report":"H7710 (DE DSNP)","part":null,"url":"https://providers.highmark.com/content/dam/highmark/en/providerresourcecenter/pdfs/all/documents/pdfs/authorization/prior-authorization-metrics/prior-authorization-metrics.pdf","readOn":"2026-10-07","stdRequests":671,"stdApproved":588,"stdDenied":83,"stdApprovedPct":88,"stdDeniedPct":12,"appeals":null,"appealApproved":null,"appealApprovedPct":null,"extendedRequests":5,"extendedApproved":5,"extendedApprovedPct":100,"expRequests":41,"expApproved":37,"expDenied":4,"expApprovedPct":90,"expDeniedPct":10,"stdAvgHours":115.2,"stdMedianHours":120,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":"standard 4.8 days mean, 5 days median; expedited <1 day mean, <1 day median","note":"Percentages printed as whole numbers. D-SNP contract (Delaware). No appeal rows printed for this contract. Expedited extension (not in schema): approved 0 of 1 (0%), denied 1 of 1 (100%).","ratePrecision":{"stdApprovedPct":0,"stdDeniedPct":0,"expApprovedPct":0,"expDeniedPct":0}},{"id":"highmark-medicaid-pa","year":2025,"payer":"Highmark","program":"medicaid-mco","report":"Medicaid and CHIP (state level), Pennsylvania","part":null,"url":"https://providers.highmark.com/content/dam/highmark/en/providerresourcecenter/pdfs/all/documents/pdfs/authorization/prior-authorization-metrics/prior-authorization-metrics.pdf","readOn":"2026-10-07","stdRequests":22141,"stdApproved":21291,"stdDenied":850,"stdApprovedPct":96,"stdDeniedPct":4,"appeals":1744,"appealApproved":606,"appealApprovedPct":35,"extendedRequests":848,"extendedApproved":764,"extendedApprovedPct":90,"expRequests":15156,"expApproved":14730,"expDenied":425,"expApprovedPct":97,"expDeniedPct":3,"stdAvgHours":35.52,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":"standard 1.48 days mean, <1 day median; expedited <1 day mean, <1 day median","note":"The file lists this under \"STATE MEDICAID AND CHIP FFS PROGRAMS AT STATE LEVEL\" (state-level, labeled FFS); program set to medicaid-mco as the closest schema value. Medicaid and CHIP are not separated. Percentages mostly whole numbers. Expedited approved 14730 + denied 425 = 15155, but total printed as 15156. Expedited extension (not in schema): approved 31 of 34 (91%). Expedited appeals (not in schema): approved 80 of 110 (73%).","ratePrecision":{"stdApprovedPct":0,"stdDeniedPct":0,"expApprovedPct":0,"expDeniedPct":0,"appealApprovedPct":0,"extendedApprovedPct":0}},{"id":"highmark-medicaid-de","year":2025,"payer":"Highmark","program":"medicaid-mco","report":"Medicaid and CHIP (state level), Delaware","part":null,"url":"https://providers.highmark.com/content/dam/highmark/en/providerresourcecenter/pdfs/all/documents/pdfs/authorization/prior-authorization-metrics/prior-authorization-metrics.pdf","readOn":"2026-10-07","stdRequests":32291,"stdApproved":31809,"stdDenied":482,"stdApprovedPct":99,"stdDeniedPct":1,"appeals":156,"appealApproved":38,"appealApprovedPct":24,"extendedRequests":932,"extendedApproved":838,"extendedApprovedPct":90,"expRequests":1098,"expApproved":1060,"expDenied":38,"expApprovedPct":97,"expDeniedPct":3,"stdAvgHours":91.2,"stdMedianHours":96,"expAvgHours":40.8,"expMedianHours":36,"timesAsPosted":"standard 3.8 days mean, 4 days median; expedited 1.7 days mean, 1.5 days median","note":"The file lists this under \"STATE MEDICAID AND CHIP FFS PROGRAMS AT STATE LEVEL\" (state-level, labeled FFS); program set to medicaid-mco as the closest schema value. Medicaid and CHIP are not separated. Percentages mostly whole numbers. Expedited extension (not in schema): approved 9 of 10 (90%). Expedited appeals (not in schema): approved 2 of 8 (25%).","ratePrecision":{"stdApprovedPct":0,"stdDeniedPct":0,"expApprovedPct":0,"expDeniedPct":0,"appealApprovedPct":0,"extendedApprovedPct":0}},{"id":"highmark-medicaid-wv","year":2025,"payer":"Highmark","program":"medicaid-mco","report":"Medicaid and CHIP (state level), West Virginia","part":null,"url":"https://providers.highmark.com/content/dam/highmark/en/providerresourcecenter/pdfs/all/documents/pdfs/authorization/prior-authorization-metrics/prior-authorization-metrics.pdf","readOn":"2026-10-07","stdRequests":1426,"stdApproved":1371,"stdDenied":55,"stdApprovedPct":96,"stdDeniedPct":4,"appeals":3,"appealApproved":0,"appealApprovedPct":0,"extendedRequests":31,"extendedApproved":30,"extendedApprovedPct":97,"expRequests":1381,"expApproved":1343,"expDenied":38,"expApprovedPct":97,"expDeniedPct":3,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":"standard <1 day mean, <1 day median; expedited <1 day mean, <1 day median","note":"The file lists this under \"STATE MEDICAID AND CHIP FFS PROGRAMS AT STATE LEVEL\" (state-level, labeled FFS); program set to medicaid-mco as the closest schema value. Medicaid and CHIP are not separated. Percentages mostly whole numbers. Standard extension rows disagree: \"approved ... 30 / 31 / 97%\" but \"denied ... 8 / 10 / 80%\". Expedited extension (not in schema): approved 10 of 12 (83%). Expedited appeals (not in schema): 0 of 0.","ratePrecision":{"stdApprovedPct":0,"stdDeniedPct":0,"expApprovedPct":0,"expDeniedPct":0,"extendedApprovedPct":0}},{"id":"highmark-medicaid-ny","year":2025,"payer":"Highmark","program":"medicaid-mco","report":"Medicaid and CHIP (state level), New York","part":null,"url":"https://providers.highmark.com/content/dam/highmark/en/providerresourcecenter/pdfs/all/documents/pdfs/authorization/prior-authorization-metrics/prior-authorization-metrics.pdf","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":91.3,"stdDeniedPct":8.7,"appeals":null,"appealApproved":null,"appealApprovedPct":39.9,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":2.9,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":94.6,"expDeniedPct":5.4,"stdAvgHours":48,"stdMedianHours":48,"expAvgHours":24,"expMedianHours":24,"timesAsPosted":"standard 2 days mean, 2 days median; expedited 1 day mean, 1 day median","note":"The file lists this under \"STATE MEDICAID AND CHIP FFS PROGRAMS AT STATE LEVEL\" (state-level, labeled FFS); program set to medicaid-mco as the closest schema value. Medicaid and CHIP are not separated. Counts print \"N/A\"; only percentages are given. Extension: \"Request approved only after time for review was extended ... 2.9%\" -- far below every other extension rate in the file; may be the share of requests extended rather than an approval rate. Expedited extension and appeal rows print \"N/A\"."},{"id":"highmark-qhp-ny","year":2025,"payer":"Highmark","program":"qhp","report":"QHP issuer on FFE, New York","part":null,"url":"https://providers.highmark.com/content/dam/highmark/en/providerresourcecenter/pdfs/all/documents/pdfs/authorization/prior-authorization-metrics/prior-authorization-metrics.pdf","readOn":"2026-10-07","stdRequests":1342,"stdApproved":1296,"stdDenied":46,"stdApprovedPct":96.57,"stdDeniedPct":96.57,"appeals":0,"appealApproved":0,"appealApprovedPct":null,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":165,"expApproved":148,"expDenied":17,"expApprovedPct":90,"expDeniedPct":10,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":"standard 0.87 mean, 0 median; expedited 0.52 mean, 0 median","note":"Times printed as bare numbers with no unit. No standard extension rows printed for QHP issuers. Standard denied printed as \"46 / 1342 / 96.57%\" -- the same percentage as approved; 46/1342 would be about 3.43%. Expedited extension and appeals (not in schema): 0 of 0. Expedited percentages are whole numbers. The file posts appealApprovedPct as 0.0% over zero requests; carried as no rate. The posted stdDeniedPct (96.57%) does not match the posted counts (46 of 1,342 is 3.43%); both are carried as posted, and this rate is left out of the market summary.","ratePrecision":{"expApprovedPct":0,"expDeniedPct":0},"rateMismatch":["stdDeniedPct"],"notPooled":["stdDeniedPct"]},{"id":"highmark-qhp-wv","year":2025,"payer":"Highmark","program":"qhp","report":"QHP issuer on FFE, West Virginia","part":null,"url":"https://providers.highmark.com/content/dam/highmark/en/providerresourcecenter/pdfs/all/documents/pdfs/authorization/prior-authorization-metrics/prior-authorization-metrics.pdf","readOn":"2026-10-07","stdRequests":25350,"stdApproved":22352,"stdDenied":2998,"stdApprovedPct":88,"stdDeniedPct":12,"appeals":20,"appealApproved":7,"appealApprovedPct":35,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":6408,"expApproved":5806,"expDenied":602,"expApprovedPct":91,"expDeniedPct":9,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":"standard 0.41 mean, 0 median; expedited 0.56 mean, 0 median","note":"Times printed as bare numbers with no unit. No standard extension rows printed for QHP issuers. Percentages printed as whole numbers. Expedited extension (not in schema): 0 of 0. Expedited appeals (not in schema): approved 2 of 9 with no percentage printed; denied 7 of 9 (78%).","ratePrecision":{"stdApprovedPct":0,"stdDeniedPct":0,"expApprovedPct":0,"expDeniedPct":0}},{"id":"highmark-qhp-de","year":2025,"payer":"Highmark","program":"qhp","report":"QHP issuer on FFE, Delaware","part":null,"url":"https://providers.highmark.com/content/dam/highmark/en/providerresourcecenter/pdfs/all/documents/pdfs/authorization/prior-authorization-metrics/prior-authorization-metrics.pdf","readOn":"2026-10-07","stdRequests":16283,"stdApproved":14939,"stdDenied":1344,"stdApprovedPct":92,"stdDeniedPct":8,"appeals":5,"appealApproved":3,"appealApprovedPct":60,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":3343,"expApproved":3056,"expDenied":287,"expApprovedPct":91,"expDeniedPct":9,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":"standard 0.68 mean, 0 median; expedited 0.51 mean, 0 median","note":"Times printed as bare numbers with no unit. No standard extension rows printed for QHP issuers. Percentages printed as whole numbers. Expedited extension (not in schema): approved 1 of 1 (100%). Expedited appeals (not in schema): approved 3 of 7 (43%).","ratePrecision":{"stdApprovedPct":0,"stdDeniedPct":0,"expApprovedPct":0,"expDeniedPct":0}},{"id":"highmark-qhp-pa","year":2025,"payer":"Highmark","program":"qhp","report":"QHP issuer on FFE, Pennsylvania","part":null,"url":"https://providers.highmark.com/content/dam/highmark/en/providerresourcecenter/pdfs/all/documents/pdfs/authorization/prior-authorization-metrics/prior-authorization-metrics.pdf","readOn":"2026-10-07","stdRequests":77677,"stdApproved":72961,"stdDenied":4716,"stdApprovedPct":94,"stdDeniedPct":6,"appeals":50,"appealApproved":27,"appealApprovedPct":54,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":13598,"expApproved":12455,"expDenied":1143,"expApprovedPct":92,"expDeniedPct":8,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":"standard 0.43 mean, 0 median; expedited 0.49 mean, 0 median","note":"Times printed as bare numbers with no unit. No standard extension rows printed for QHP issuers. Percentages printed as whole numbers. Expedited extension (not in schema): approved 17 of 18 (94%). Expedited appeals (not in schema): approved 4 of 16 (25%).","ratePrecision":{"stdApprovedPct":0,"stdDeniedPct":0,"expApprovedPct":0,"expDeniedPct":0}},{"id":"ks-ma-h7063","year":2025,"payer":"Blue Cross and Blue Shield of Kansas","program":"ma","report":"H7063 Blue Cross and Blue Shield of Kansas Medicare Advantage","part":null,"url":"https://www.bcbsks.com/documents/2025-prior-authorization-metrics-medicare-advantage","readOn":"2026-10-07","stdRequests":1974,"stdApproved":1910,"stdDenied":64,"stdApprovedPct":97,"stdDeniedPct":3,"appeals":4,"appealApproved":3,"appealApprovedPct":75,"extendedRequests":0,"extendedApproved":0,"extendedApprovedPct":null,"expRequests":88,"expApproved":86,"expDenied":2,"expApprovedPct":98,"expDeniedPct":2,"stdAvgHours":139.2,"stdMedianHours":134.4,"expAvgHours":40.94,"expMedianHours":28.32,"timesAsPosted":"standard 5.8 days mean, 5.6 days median; expedited 40.94 hours mean, 28.32 hours median","note":"Contract id H7063 is read from the page-footer material code \"H7063_PAReqs26_C\"; the file names no plan. Percentages are posted to whole numbers. Non-urgent appeals: 3 approved and 1 denied \"after appeal\" out of 4. Extension rows print 0 out of 0 with a percentage of \"0%\" (standard and urgent). The file posts extendedApprovedPct as 0% over zero requests; carried as no rate.","ratePrecision":{"stdApprovedPct":0,"stdDeniedPct":0,"expApprovedPct":0,"expDeniedPct":0}},{"id":"ks-qhp","year":2025,"payer":"Blue Cross and Blue Shield of Kansas","program":"qhp","report":"Blue Cross and Blue Shield of Kansas QHP (Kansas)","part":null,"url":"https://www.bcbsks.com/documents/2025-prior-authorization-metrics-qualified-health-plan","readOn":"2026-10-07","stdRequests":3998,"stdApproved":3854,"stdDenied":136,"stdApprovedPct":96.4,"stdDeniedPct":3.4,"appeals":101,"appealApproved":59,"appealApprovedPct":58.42,"extendedRequests":0,"extendedApproved":0,"extendedApprovedPct":null,"expRequests":1,"expApproved":1,"expDenied":0,"expApprovedPct":100,"expDeniedPct":0,"stdAvgHours":192,"stdMedianHours":192,"expAvgHours":51.12,"expMedianHours":48,"timesAsPosted":"standard 8 Days mean, 8 days median; expedited 2.13 Days mean, 2 days median","note":"Market not named beyond \"QHP issuers on the FFEs\" timeframe language; footer code \"709_PAReqs_03/26\". Standard approved 3,854 + denied 136 = 3,990, not the printed total of 3,998. Appeals: 59 approved + 34 denied (\"Request denied after appeal\" 34 of 101, 33.66%) = 93, not 101. Urgent: approved printed \"1 out of 1, 100%\" but denied printed \"0 out of 0, 0%\" (inconsistent denominators); expDeniedPct copied as 0. Extension rows print 0 out of 0 with a percentage of \"0%\" (standard and urgent). The file posts extendedApprovedPct as 0% over zero requests; carried as no rate."},{"id":"az-ma","year":2025,"payer":"Blue Cross Blue Shield of Arizona","program":"ma","report":"AZ Blue Medicare Advantage (MA Blue Best Life Plus HMO and MA Blue Best Life Classic HMO), Arizona","part":null,"url":"https://assets.azblue.com/m/4f85025f7b61a595/original/2025-MA-Prior-Auth-Metrics-Report.pdf","readOn":"2026-10-07","stdRequests":37315,"stdApproved":35217,"stdDenied":2098,"stdApprovedPct":94.38,"stdDeniedPct":5.62,"appeals":477,"appealApproved":434,"appealApprovedPct":90.99,"extendedRequests":37135,"extendedApproved":18,"extendedApprovedPct":0.05,"expRequests":4443,"expApproved":4174,"expDenied":269,"expApprovedPct":93.95,"expDeniedPct":6.05,"stdAvgHours":50.64,"stdMedianHours":null,"expAvgHours":11.83,"expMedianHours":2.52,"timesAsPosted":"standard 2.11 days mean, <1 day median; expedited 11.83 hours mean, 2.52 hours median","note":"One report covers two MA plans (MA Blue Best Life Plus HMO and Classic HMO); no contract id is printed. The extension rate is posted out of all standard requests (the printed denominator), not out of extended requests; the file gives no count of requests whose review was extended. Table 2 prints the extension denominator as 37,135 while Table 1 prints 37,315 standard requests (likely a transposition; 18/either rounds to 0.05%). Expedited extension (Table 5): 1 approved after extension out of 4,443 expedited requests, 0.02%."},{"id":"az-dsnp","year":2025,"payer":"Blue Cross Blue Shield of Arizona","program":"ma","report":"AZ Blue Health Choice Pathway (Medicare Advantage D-SNP), Arizona","part":null,"url":"https://assets.azblue.com/m/7d1ddd4e92f179c2/original/2025-DSNP-Metrics-Report.pdf","readOn":"2026-10-07","stdRequests":11931,"stdApproved":10928,"stdDenied":1003,"stdApprovedPct":91.59,"stdDeniedPct":8.41,"appeals":138,"appealApproved":71,"appealApprovedPct":51.45,"extendedRequests":11931,"extendedApproved":6,"extendedApprovedPct":0.05,"expRequests":1218,"expApproved":1136,"expDenied":82,"expApprovedPct":93.27,"expDeniedPct":6.73,"stdAvgHours":90.72,"stdMedianHours":47.52,"expAvgHours":19.93,"expMedianHours":2.82,"timesAsPosted":"standard 3.78 days mean, 1.98 days median; expedited 19.93 hours mean, 2.82 hours median","note":"D-SNP plan; no contract id is printed. The extension rate is posted out of all standard requests (the printed denominator), not out of extended requests; the file gives no count of requests whose review was extended. Expedited extension (Table 5): 0 approved after extension out of 1,218 expedited requests, 0%."},{"id":"az-qhp","year":2025,"payer":"Blue Cross Blue Shield of Arizona","program":"qhp","report":"AZ Blue Individual ACA plans, Arizona","part":null,"url":"https://assets.azblue.com/m/3a748505efc6198f/original/2025-ACA-Prior-Auth-Metrics-Report.pdf","readOn":"2026-10-07","stdRequests":34329,"stdApproved":29927,"stdDenied":4402,"stdApprovedPct":87.18,"stdDeniedPct":12.82,"appeals":363,"appealApproved":164,"appealApprovedPct":45.18,"extendedRequests":34329,"extendedApproved":31,"extendedApprovedPct":0.09,"expRequests":3124,"expApproved":2832,"expDenied":292,"expApprovedPct":90.65,"expDeniedPct":9.35,"stdAvgHours":82.8,"stdMedianHours":7.68,"expAvgHours":20.36,"expMedianHours":2.9,"timesAsPosted":"standard 3.45 days mean, 0.32 days median; expedited 20.36 hours mean, 2.9 hours median","note":"Covers individual ACA plan members of plans managed by AZ Blue and by Health Choice (ACA StandardHealth with Health Choice) together; on/off-exchange split not stated. The extension rate is posted out of all standard requests (the printed denominator), not out of extended requests; the file gives no count of requests whose review was extended. Expedited extension (Table 5): 2 approved after extension out of 3,124 expedited requests, 0.06%."},{"id":"az-mcd","year":2025,"payer":"Blue Cross Blue Shield of Arizona","program":"medicaid-mco","report":"Blue Cross Blue Shield of Arizona Health Choice (Arizona Medicaid)","part":null,"url":"https://assets.azblue.com/m/111e9ce8c59e052a/original/2025-Medicaid-Metrics-Report.pdf","readOn":"2026-10-07","stdRequests":71937,"stdApproved":63222,"stdDenied":8715,"stdApprovedPct":87.89,"stdDeniedPct":12.11,"appeals":296,"appealApproved":111,"appealApprovedPct":37.5,"extendedRequests":71937,"extendedApproved":49,"extendedApprovedPct":0.07,"expRequests":10209,"expApproved":9416,"expDenied":793,"expApprovedPct":92.23,"expDeniedPct":7.77,"stdAvgHours":95.04,"stdMedianHours":26.16,"expAvgHours":16.1,"expMedianHours":2.78,"timesAsPosted":"standard 3.96 days mean, 1.09 days median; expedited 16.10 hours mean, 2.78 hours median","note":"The extension rate is posted out of all standard requests (the printed denominator), not out of extended requests; the file gives no count of requests whose review was extended. Expedited extension (Table 5): 4 approved after extension out of 10,209 expedited requests, 0.04%. Narrative says \"About 3 out of 10\" requests are approved after appeal; the table prints 37.50%."},{"id":"sh-ma-h2246","year":2025,"payer":"Select Health","program":"ma","report":"H2246 (Medicare; plan name not printed)","part":null,"url":"https://selecthealth.org/content/dam/selecthealth/Provider/PDFs/preauthorization/metrics/cms-prior-auth-metrics-2025-medicare-h2246.pdf","readOn":"2026-10-07","stdRequests":1548,"stdApproved":1431,"stdDenied":117,"stdApprovedPct":92,"stdDeniedPct":8,"appeals":8,"appealApproved":7,"appealApprovedPct":88,"extendedRequests":0,"extendedApproved":0,"extendedApprovedPct":null,"expRequests":59,"expApproved":53,"expDenied":6,"expApprovedPct":90,"expDeniedPct":10,"stdAvgHours":48,"stdMedianHours":24,"expAvgHours":17,"expMedianHours":5,"timesAsPosted":"standard 2 days mean, 1 day median; expedited 17 hours mean, 5 hours median","note":"Percentages are posted to whole numbers. Times are printed as bare whole numbers under row labels \"in Days\" (standard) and \"in Hours\" (urgent); units taken from those labels. Non-urgent appeals: 1 denied after appeal of 8 (13%). Urgent appeals: 1 approved of 1 (100%), 0 denied. Extension rows print 0 of 0 with \"0%\" (standard and urgent). The file posts extendedApprovedPct as 0% over zero requests; carried as no rate.","ratePrecision":{"stdApprovedPct":0,"stdDeniedPct":0,"expApprovedPct":0,"expDeniedPct":0,"appealApprovedPct":0}},{"id":"sh-ma-h1994","year":2025,"payer":"Select Health","program":"ma","report":"H1994 (Medicare; plan name not printed)","part":null,"url":"https://selecthealth.org/content/dam/selecthealth/Provider/PDFs/preauthorization/metrics/cms-prior-auth-metrics-2025-medicare-h1994.pdf","readOn":"2026-10-07","stdRequests":42986,"stdApproved":40525,"stdDenied":2461,"stdApprovedPct":94,"stdDeniedPct":6,"appeals":152,"appealApproved":147,"appealApprovedPct":97,"extendedRequests":3,"extendedApproved":2,"extendedApprovedPct":67,"expRequests":1795,"expApproved":1713,"expDenied":82,"expApprovedPct":95,"expDeniedPct":5,"stdAvgHours":48,"stdMedianHours":24,"expAvgHours":20,"expMedianHours":6,"timesAsPosted":"standard 2 days mean, 1 day median; expedited 20 hours mean, 6 hours median","note":"Percentages are posted to whole numbers. Times are printed as bare whole numbers under row labels \"in Days\" (standard) and \"in Hours\" (urgent); units taken from those labels. Non-urgent appeals: 5 denied after appeal of 152 (3%). Standard extension: 1 denied after extension of 3 (33%). Urgent appeals: 42 approved of 42 (100%), 0 denied. Urgent extension: 0 approved and 1 denied of 1 (100%).","ratePrecision":{"stdApprovedPct":0,"stdDeniedPct":0,"expApprovedPct":0,"expDeniedPct":0,"appealApprovedPct":0,"extendedApprovedPct":0}},{"id":"sh-medicaid","year":2025,"payer":"Select Health","program":"medicaid-mco","report":"Select Health Medicaid (state not printed)","part":null,"url":"https://selecthealth.org/content/dam/selecthealth/Provider/PDFs/preauthorization/metrics/cms-prior-auth-metrics-medicaid-2025.pdf","readOn":"2026-10-07","stdRequests":26005,"stdApproved":24180,"stdDenied":1825,"stdApprovedPct":93,"stdDeniedPct":7,"appeals":1027,"appealApproved":461,"appealApprovedPct":45,"extendedRequests":136,"extendedApproved":104,"extendedApprovedPct":76,"expRequests":1021,"expApproved":890,"expDenied":131,"expApprovedPct":87,"expDeniedPct":13,"stdAvgHours":24,"stdMedianHours":0,"expAvgHours":15,"expMedianHours":4,"timesAsPosted":"standard 1 day mean, 0 days median; expedited 15 hours mean, 4 hours median","note":"Percentages are posted to whole numbers. Times are printed as bare whole numbers under row labels \"in Days\" (standard) and \"in Hours\" (urgent); units taken from those labels. Non-urgent appeals: 566 denied after appeal of 1,027 (55%). Standard extension: 32 denied after extension of 136 (24%). Urgent appeals: 37 approved, 8 denied of 45 (82% / 18%). Urgent extension: 7 approved, 5 denied of 12 (58% / 42%).","ratePrecision":{"expApprovedPct":0,"expDeniedPct":0,"appealApprovedPct":0,"extendedApprovedPct":0}},{"id":"sh-chip","year":2025,"payer":"Select Health","program":"chip-mco","report":"Select Health CHIP (state not printed)","part":null,"url":"https://selecthealth.org/content/dam/selecthealth/Provider/PDFs/preauthorization/metrics/cms-prior-auth-metrics-chip-2025.pdf","readOn":"2026-10-07","stdRequests":491,"stdApproved":443,"stdDenied":48,"stdApprovedPct":90,"stdDeniedPct":10,"appeals":28,"appealApproved":11,"appealApprovedPct":39,"extendedRequests":4,"extendedApproved":4,"extendedApprovedPct":100,"expRequests":37,"expApproved":29,"expDenied":8,"expApprovedPct":78,"expDeniedPct":22,"stdAvgHours":48,"stdMedianHours":0,"expAvgHours":13,"expMedianHours":2,"timesAsPosted":"standard 2 days mean, 0 days median; expedited 13 hours mean, 2 hours median","note":"Percentages are posted to whole numbers. Times are printed as bare whole numbers under row labels \"in Days\" (standard) and \"in Hours\" (urgent); units taken from those labels. Non-urgent appeals: 17 denied after appeal of 28 (61%). Standard extension: 0 denied after extension of 4 (0%). Urgent appeals and extensions print 0 of 0 with \"0%\".","ratePrecision":{"stdApprovedPct":0,"stdDeniedPct":0,"expApprovedPct":0,"expDeniedPct":0,"appealApprovedPct":0}},{"id":"sh-qhp-26002","year":2025,"payer":"Select Health","program":"qhp","report":"QHP-26002 (HIOS issuer 26002; state not printed)","part":null,"url":"https://selecthealth.org/content/dam/selecthealth/Provider/PDFs/preauthorization/metrics/cms-prior-auth-metrics-2025-qhp-26002.pdf","readOn":"2026-10-07","stdRequests":5929,"stdApproved":5202,"stdDenied":727,"stdApprovedPct":88,"stdDeniedPct":12,"appeals":737,"appealApproved":171,"appealApprovedPct":23,"extendedRequests":50,"extendedApproved":34,"extendedApprovedPct":68,"expRequests":292,"expApproved":257,"expDenied":35,"expApprovedPct":88,"expDeniedPct":12,"stdAvgHours":24,"stdMedianHours":0,"expAvgHours":24,"expMedianHours":5,"timesAsPosted":"standard 1 day mean, 0 days median; expedited 24 hours mean, 5 hours median","note":"Percentages are posted to whole numbers. Times are printed as bare whole numbers under row labels \"in Days\" (standard) and \"in Hours\" (urgent); units taken from those labels. Non-urgent appeals: 566 denied after appeal of 737 (77%). Standard extension: 16 denied after extension of 50 (32%). Urgent appeals: 27 approved, 70 denied of 97 (28% / 72%). Urgent extension rows print 0 of 0 with \"0%\".","ratePrecision":{"stdApprovedPct":0,"stdDeniedPct":0,"appealApprovedPct":0}},{"id":"sh-qhp-68781","year":2025,"payer":"Select Health","program":"qhp","report":"QHP-68781 (HIOS issuer 68781; state not printed)","part":null,"url":"https://selecthealth.org/content/dam/selecthealth/Provider/PDFs/preauthorization/metrics/cms-prior-auth-metrics-2025-qhp-68781.pdf","readOn":"2026-10-07","stdRequests":44250,"stdApproved":39533,"stdDenied":4717,"stdApprovedPct":89,"stdDeniedPct":11,"appeals":3397,"appealApproved":762,"appealApprovedPct":22,"extendedRequests":102,"extendedApproved":63,"extendedApprovedPct":62,"expRequests":1457,"expApproved":1255,"expDenied":202,"expApprovedPct":86,"expDeniedPct":14,"stdAvgHours":48,"stdMedianHours":0,"expAvgHours":26,"expMedianHours":4,"timesAsPosted":"standard 2 days mean, 0 days median; expedited 26 hours mean, 4 hours median","note":"Percentages are posted to whole numbers. Times are printed as bare whole numbers under row labels \"in Days\" (standard) and \"in Hours\" (urgent); units taken from those labels. Non-urgent appeals: 2,635 denied after appeal of 3,397 (78%). Standard extension: 39 denied after extension of 102 (38%). Urgent appeals: 104 approved, 329 denied of 433 (24% / 76%). Urgent extension rows print 0 of 0 with \"0%\".","ratePrecision":{"stdApprovedPct":0,"stdDeniedPct":0,"expApprovedPct":0,"expDeniedPct":0,"appealApprovedPct":0,"extendedApprovedPct":0}},{"id":"wm-ia","year":2025,"payer":"Wellmark Blue Cross and Blue Shield","program":"qhp","report":"Wellmark Iowa plans on the FFEs (Iowa)","part":null,"url":"https://digital-assets.wellmark.com/adobe/assets/urn:aaid:aem:30eb26f4-5bfc-49b3-bd1b-7d4ef5245ecd/original/as/prior-authorization-metrics-iowa.pdf","readOn":"2026-10-07","stdRequests":25301,"stdApproved":22505,"stdDenied":2796,"stdApprovedPct":89,"stdDeniedPct":11.1,"appeals":199,"appealApproved":78,"appealApprovedPct":39.2,"extendedRequests":0,"extendedApproved":0,"extendedApprovedPct":null,"expRequests":5599,"expApproved":5316,"expDenied":283,"expApprovedPct":95,"expDeniedPct":5.1,"stdAvgHours":44.88,"stdMedianHours":0,"expAvgHours":20.88,"expMedianHours":21.12,"timesAsPosted":"standard 1.87 days mean, 0 days median; expedited 0.87 days mean, 0.88 days median","note":"Iowa members on the Federally Facilitated Exchanges only. Standard approved prints 89.0% but 22,505/25,301 = 88.95%; with 11.1% denied the pair sums to 100.1%. Expedited approved prints 95.0% but 5,316/5,599 = 94.95%; with 5.1% denied the pair sums to 100.1%. Median standard time printed \"0 days*\": footnote says more than half of standard requests were approved in real time. Extension rows print 0 of 0 with \"0%\" (standard and expedited). The standard turnaround row is labeled \"response due to provider within 7 calendar days\" although the same file says QHP issuers on the FFEs have 15 days. The file posts extendedApprovedPct as 0% over zero requests; carried as no rate. The posted expApprovedPct (95.0%) does not match the posted counts (5,316 of 5,599 is 94.95%); both are carried as posted, and this rate is left out of the market summary.","rateMismatch":["expApprovedPct"],"notPooled":["expApprovedPct"]},{"id":"wm-sd","year":2025,"payer":"Wellmark Blue Cross and Blue Shield","program":"qhp","report":"Wellmark South Dakota plans on the FFEs (South Dakota)","part":null,"url":"https://digital-assets.wellmark.com/adobe/assets/urn:aaid:aem:8cd27035-5608-42e2-a851-c5fe2cf98538/original/as/prior-authorization-metrics-south-dakota.pdf","readOn":"2026-10-07","stdRequests":2741,"stdApproved":2408,"stdDenied":333,"stdApprovedPct":87.9,"stdDeniedPct":12.2,"appeals":27,"appealApproved":8,"appealApprovedPct":29.6,"extendedRequests":0,"extendedApproved":0,"extendedApprovedPct":null,"expRequests":498,"expApproved":469,"expDenied":29,"expApprovedPct":94.2,"expDeniedPct":5.8,"stdAvgHours":52.56,"stdMedianHours":0,"expAvgHours":9.84,"expMedianHours":1.92,"timesAsPosted":"standard 2.19 days mean, 0 days median; expedited 0.41 days mean, 0.08 days median","note":"South Dakota members on the Federally Facilitated Exchanges only. Standard denied prints 12.2% but 333/2,741 = 12.15%; with 87.9% approved the pair sums to 100.1%. Median standard time printed \"0 days*\": footnote says more than half of standard requests were approved in real time. Extension rows print 0 of 0 with \"0%\" (standard and expedited). The standard turnaround row is labeled \"response due to provider within 7 calendar days\" although the same file says QHP issuers on the FFEs have 15 days. The file posts extendedApprovedPct as 0% over zero requests; carried as no rate. The posted stdDeniedPct (12.2%) does not match the posted counts (333 of 2,741 is 12.15%); both are carried as posted, and this rate is left out of the market summary.","rateMismatch":["stdDeniedPct"],"notPooled":["stdDeniedPct"]},{"id":"bsc-ma-h0504","year":2025,"payer":"Blue Shield of California","program":"ma","report":"H0504 Medicare Advantage HMO","part":null,"url":"https://cloud-web.blueshieldca.com/content/dam/bsca/en/medicare/docs/2025/pharmacy/Prior-Auth-Metrics-Medicare-2025.pdf","readOn":"2026-10-07","stdRequests":451021,"stdApproved":444087,"stdDenied":6934,"stdApprovedPct":98,"stdDeniedPct":2,"appeals":267,"appealApproved":185,"appealApprovedPct":69,"extendedRequests":176,"extendedApproved":135,"extendedApprovedPct":77,"expRequests":59270,"expApproved":57828,"expDenied":1442,"expApprovedPct":98,"expDeniedPct":2,"stdAvgHours":72,"stdMedianHours":0,"expAvgHours":14,"expMedianHours":6,"timesAsPosted":"standard 3 days mean, 0 days median; expedited 14 hours mean, 6 hours median","note":"File reports four MA contracts separately; values are per contract. Response times printed as bare numbers; units come from the section headings ('in hours' for urgent, 'in calendar days' for non-urgent). Percentages posted to whole numbers. Appeal slot holds non-urgent appeals; extension slot holds non-urgent extensions. Urgent extensions: 49 extended, 37 approved after extension (76%). Urgent appeals: 125 appeals, 91 approved only after appeal (73%).","ratePrecision":{"stdApprovedPct":0,"stdDeniedPct":0,"expApprovedPct":0,"expDeniedPct":0,"appealApprovedPct":0,"extendedApprovedPct":0}},{"id":"bsc-ma-h2819","year":2025,"payer":"Blue Shield of California","program":"ma","report":"H2819 Medicare Advantage DSNP","part":null,"url":"https://cloud-web.blueshieldca.com/content/dam/bsca/en/medicare/docs/2025/pharmacy/Prior-Auth-Metrics-Medicare-2025.pdf","readOn":"2026-10-07","stdRequests":122926,"stdApproved":121309,"stdDenied":1617,"stdApprovedPct":99,"stdDeniedPct":1,"appeals":74,"appealApproved":60,"appealApprovedPct":81,"extendedRequests":17,"extendedApproved":10,"extendedApprovedPct":59,"expRequests":13775,"expApproved":13392,"expDenied":383,"expApprovedPct":97,"expDeniedPct":3,"stdAvgHours":72,"stdMedianHours":0,"expAvgHours":12,"expMedianHours":8,"timesAsPosted":"standard 3 days mean, 0 days median; expedited 12 hours mean, 8 hours median","note":"File reports four MA contracts separately; values are per contract. Response times printed as bare numbers; units come from the section headings ('in hours' for urgent, 'in calendar days' for non-urgent). Percentages posted to whole numbers. Appeal slot holds non-urgent appeals; extension slot holds non-urgent extensions. Urgent extensions: 6 extended, 2 approved after extension (33%). Urgent appeals: 36 appeals, 27 approved only after appeal (75%).","ratePrecision":{"stdApprovedPct":0,"stdDeniedPct":0,"expApprovedPct":0,"expDeniedPct":0,"appealApprovedPct":0,"extendedApprovedPct":0}},{"id":"bsc-ma-h4937","year":2025,"payer":"Blue Shield of California","program":"ma","report":"H4937 Medicare Advantage PPO","part":null,"url":"https://cloud-web.blueshieldca.com/content/dam/bsca/en/medicare/docs/2025/pharmacy/Prior-Auth-Metrics-Medicare-2025.pdf","readOn":"2026-10-07","stdRequests":3829,"stdApproved":3368,"stdDenied":461,"stdApprovedPct":88,"stdDeniedPct":12,"appeals":145,"appealApproved":108,"appealApprovedPct":74,"extendedRequests":195,"extendedApproved":130,"extendedApprovedPct":67,"expRequests":559,"expApproved":546,"expDenied":13,"expApprovedPct":98,"expDeniedPct":2,"stdAvgHours":96,"stdMedianHours":72,"expAvgHours":25,"expMedianHours":18,"timesAsPosted":"standard 4 days mean, 3 days median; expedited 25 hours mean, 18 hours median","note":"File reports four MA contracts separately; values are per contract. Response times printed as bare numbers; units come from the section headings ('in hours' for urgent, 'in calendar days' for non-urgent). Percentages posted to whole numbers. Appeal slot holds non-urgent appeals; extension slot holds non-urgent extensions. Urgent extensions: 14 extended, 9 approved after extension (64%). Urgent appeals: 114 appeals, 76 approved only after appeal (67%).","ratePrecision":{"expApprovedPct":0,"expDeniedPct":0,"appealApprovedPct":0,"extendedApprovedPct":0}},{"id":"bsc-ma-h5928","year":2025,"payer":"Blue Shield of California","program":"ma","report":"H5928 Medicare Advantage HMO","part":null,"url":"https://cloud-web.blueshieldca.com/content/dam/bsca/en/medicare/docs/2025/pharmacy/Prior-Auth-Metrics-Medicare-2025.pdf","readOn":"2026-10-07","stdRequests":67137,"stdApproved":66127,"stdDenied":1010,"stdApprovedPct":98,"stdDeniedPct":2,"appeals":28,"appealApproved":20,"appealApprovedPct":71,"extendedRequests":21,"extendedApproved":18,"extendedApprovedPct":86,"expRequests":7251,"expApproved":7099,"expDenied":152,"expApprovedPct":98,"expDeniedPct":2,"stdAvgHours":48,"stdMedianHours":0,"expAvgHours":10,"expMedianHours":5,"timesAsPosted":"standard 2 days mean, 0 days median; expedited 10 hours mean, 5 hours median","note":"File reports four MA contracts separately; values are per contract. Response times printed as bare numbers; units come from the section headings ('in hours' for urgent, 'in calendar days' for non-urgent). Percentages posted to whole numbers. Appeal slot holds non-urgent appeals; extension slot holds non-urgent extensions. Urgent extensions: 1 extended, 0 approved after extension (0%). Urgent appeals: 7 appeals, 6 approved only after appeal (86%).","ratePrecision":{"stdApprovedPct":0,"stdDeniedPct":0,"expApprovedPct":0,"expDeniedPct":0,"appealApprovedPct":0,"extendedApprovedPct":0}},{"id":"lac-mcd","year":2025,"payer":"L.A. Care Health Plan","program":"medicaid-mco","report":"L.A. Care Medi-Cal, California","part":null,"url":"https://lacare.org/sites/default/files/la7598_mcla_cms57f_pa_report_202603.pdf","readOn":"2026-10-07","stdRequests":2152883,"stdApproved":2112850,"stdDenied":40033,"stdApprovedPct":98.14,"stdDeniedPct":1.86,"appeals":null,"appealApproved":165,"appealApprovedPct":null,"extendedRequests":null,"extendedApproved":8043,"extendedApprovedPct":null,"expRequests":350767,"expApproved":337522,"expDenied":13245,"expApprovedPct":96.22,"expDeniedPct":3.78,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":"standard not posted mean, not posted median; expedited not posted mean, not posted median","note":"File also prints approvals split as 'Approved Initially' / 'Approved After Extension' / 'Approved After Appeal' with total PA approvals as the denominator; the number of extended requests and of appeals is not printed, so those counts and rates are null. Standard: approved after extension 8,043 (printed 0.38% of 2,112,850 approvals); approved after appeal 165 (printed 0.01% of approvals). Expedited: approved after extension 2,583 (printed 0.77% of 337,522 approvals); no expedited appeal row printed. No response-time figures printed. Reported at the Medi-Cal plan level (all of L.A. Care Medi-Cal)."},{"id":"lac-dsnp","year":2025,"payer":"L.A. Care Health Plan","program":"ma","report":"L.A. Care Medicare Plus (HMO D-SNP)","part":null,"url":"https://lacare.org/sites/default/files/la7598_dsnp_cms57f_pa_report_202603.pdf","readOn":"2026-10-07","stdRequests":284406,"stdApproved":281471,"stdDenied":2935,"stdApprovedPct":98.96,"stdDeniedPct":1.03,"appeals":null,"appealApproved":31,"appealApprovedPct":null,"extendedRequests":null,"extendedApproved":32,"extendedApprovedPct":null,"expRequests":31016,"expApproved":30377,"expDenied":639,"expApprovedPct":97.94,"expDeniedPct":2.06,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":"standard not posted mean, not posted median; expedited not posted mean, not posted median","note":"File also prints approvals split as 'Approved Initially' / 'Approved After Extension' / 'Approved After Appeal' with total PA approvals as the denominator; the number of extended requests and of appeals is not printed, so those counts and rates are null. Contract id not printed. Standard: approved after extension 32 (printed 0.01% of 281,471 approvals); approved after appeal 31 (printed 0.01% of approvals). Expedited: approved after extension 9 (printed 0.03% of 30,377 approvals); no expedited appeal row printed. Printed standard approved 98.96% but 281,471/284,406 = 98.968% (would round to 98.97%); printed 98.96% + 1.03% = 99.99%. No response-time figures printed."},{"id":"ibx-ppo-h3909","year":2025,"payer":"Independence Blue Cross","program":"ma","report":"H3909 Personal Choice 65 PPO","part":null,"url":"https://www.ibx.com/pdfs/medicare/get-care/prior-authorization-metrics-ppo.pdf","readOn":"2026-10-07","stdRequests":70963,"stdApproved":67818,"stdDenied":3145,"stdApprovedPct":95.6,"stdDeniedPct":4.4,"appeals":354,"appealApproved":68,"appealApprovedPct":19.2,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":134,"expApproved":115,"expDenied":19,"expApprovedPct":85.8,"expDeniedPct":14.2,"stdAvgHours":30.96,"stdMedianHours":168,"expAvgHours":21.36,"expMedianHours":28.56,"timesAsPosted":"standard 1.29 days mean, 7 days median; expedited .89 days mean, 1.19 days median","note":"Expedited appeals: 2 approved only after appeal of 2 appealed (100%). Appeal denominator is 'Total denied authorizations appealed'. No extension figures printed. Times printed in days in the table ('number of days'). Data includes Independence Blue Cross and its delegated vendors. Contract id H3909 taken from the footer marketing code Y0041_H3909_26_128467_M; the page title is 'Personal Choice 65 PPO'. Standard median (7 days) is far above the mean (1.29 days) as printed; expedited median (1.19 days) also above mean (.89 days)."},{"id":"ibx-hmo-h3952","year":2025,"payer":"Independence Blue Cross","program":"ma","report":"H3952 Keystone 65 HMO","part":null,"url":"https://www.ibx.com/pdfs/medicare/get-care/prior-authorization-metrics-hmo.pdf","readOn":"2026-10-07","stdRequests":122830,"stdApproved":115554,"stdDenied":7278,"stdApprovedPct":94.1,"stdDeniedPct":5.9,"appeals":739,"appealApproved":117,"appealApprovedPct":15.8,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":205,"expApproved":174,"expDenied":31,"expApprovedPct":84.9,"expDeniedPct":15.1,"stdAvgHours":30.72,"stdMedianHours":190.08,"expAvgHours":20.64,"expMedianHours":31.44,"timesAsPosted":"standard 1.28 days mean, 7.92 days median; expedited .86 days mean, 1.31 days median","note":"Expedited appeals: 1 approved only after appeal of 1 appealed (100%). Appeal denominator is 'Total denied authorizations appealed'. No extension figures printed. Times printed in days in the table ('number of days'). Data includes Independence Blue Cross and its delegated vendors. Contract id H3952 taken from the footer marketing code Y0041_H3952_26_128465_M; the page title is 'Keystone 65 HMO'; covers HMO and HMO-POS plans. Printed standard approved 115,554 + denied 7,278 = 122,832, not the printed total 122,830. Standard median (7.92 days) is far above the mean (1.28 days) as printed; expedited median (1.31 days) also above mean (.86 days)."},{"id":"bcbst-mcd","year":2025,"payer":"BlueCross BlueShield of Tennessee","program":"medicaid-mco","report":"BlueCare, Tennessee","part":null,"url":"https://www.bcbst.com/docs/about/our-company/corporate-governance/bluecare_prior_auth_report.pdf","readOn":"2026-10-07","stdRequests":380642,"stdApproved":357562,"stdDenied":23080,"stdApprovedPct":93.94,"stdDeniedPct":6.06,"appeals":534,"appealApproved":329,"appealApprovedPct":61.61,"extendedRequests":0,"extendedApproved":0,"extendedApprovedPct":null,"expRequests":4341,"expApproved":4218,"expDenied":123,"expApprovedPct":97.17,"expDeniedPct":2.83,"stdAvgHours":70.8,"stdMedianHours":24,"expAvgHours":30.88,"expMedianHours":0,"timesAsPosted":"standard 2.95 days mean, 1 day median; expedited 30.88 hours mean, 0 hours median","note":"Issued by BlueCare Tennessee (BCBST subsidiary); BlueCare is the TennCare Medicaid plan (program name not printed beyond 'BlueCare'). Standard counts are per service/procedure: one request can list several services and each counts. Extension zeros come from the text: 'We didn't have any extension requests for BlueCare Tennessee members during the reporting period.'. Appeal row printed in the standard section only; no expedited appeal figure. Expedited mean 30.88 hours with median 0 hours, as printed."},{"id":"bcbst-dsnp-h7917","year":2025,"payer":"BlueCross BlueShield of Tennessee","program":"ma","report":"H7917 BlueCare Plus (HMO D-SNP)","part":null,"url":"https://content.bcbst.com/api/public/content/bcp-bluecare-plus-prior-auth-report.pdf","readOn":"2026-10-07","stdRequests":109960,"stdApproved":98583,"stdDenied":11377,"stdApprovedPct":89.65,"stdDeniedPct":10.35,"appeals":633,"appealApproved":497,"appealApprovedPct":78.52,"extendedRequests":null,"extendedApproved":47,"extendedApprovedPct":null,"expRequests":280,"expApproved":239,"expDenied":41,"expApprovedPct":85.36,"expDeniedPct":14.64,"stdAvgHours":54.96,"stdMedianHours":24,"expAvgHours":18.37,"expMedianHours":4,"timesAsPosted":"standard 2.29 days mean, 1 day median; expedited 18.37 hours mean, 4 hours median","note":"Contract id H7917 taken from the footer code H7917_26CMS-PA-Report_C. Single extension figure covering standard and expedited combined: 47 approved after extension out of 110,240 total requests (0.0426%); the denominator is all requests, not extended requests, so extendedRequests and extendedApprovedPct are null. Appeal row printed in the standard section only; no expedited appeal figure."},{"id":"ph-ma-h2320","year":2025,"payer":"Priority Health","program":"ma","report":"H2320 Medicare","part":null,"url":"https://priorityhealth.stylelabs.cloud/api/public/content/2025_Prior_Authorization_Metrics_-__Medicare_H2320.pdf_downloadOriginal?v=413bbbb1","readOn":"2026-10-07","stdRequests":143530,"stdApproved":133450,"stdDenied":10080,"stdApprovedPct":93,"stdDeniedPct":7,"appeals":1640,"appealApproved":1199,"appealApprovedPct":73,"extendedRequests":null,"extendedApproved":0,"extendedApprovedPct":null,"expRequests":5520,"expApproved":5100,"expDenied":420,"expApprovedPct":91,"expDeniedPct":8,"stdAvgHours":49.44,"stdMedianHours":24,"expAvgHours":20.31,"expMedianHours":24,"timesAsPosted":"standard 2.06 days mean, 1 day median; expedited 20.31 hours mean, 24 hours median","note":"Percentages posted to whole numbers. Extension rows print 0 approved and 0 denied only after an extension, against total requests; number of extended requests not printed. Standard appeals also print 264 denied only after appeal of 1640 (16%). Expedited appeals: 424 approved only after appeal of 478 (89%), 40 denied (8%). Time units printed once per row ('Days' / 'Hours') between the mean and median columns; applied to both. File also prints approved/denied within 14 days (133,341 / 9,740) and within 72 hours (5,008 / 364). Printed expedited approved 91% but 5,100/5,520 = 92.4%; printed 91% + 8% = 99%. The posted expApprovedPct (91%) does not match the posted counts (5,100 of 5,520 is 92.39%); both are carried as posted, and this rate is left out of the market summary.","ratePrecision":{"expDeniedPct":0,"appealApprovedPct":0},"rateMismatch":["expApprovedPct"],"notPooled":["expApprovedPct"]},{"id":"ph-ma-h4875","year":2025,"payer":"Priority Health","program":"ma","report":"H4875 Medicare","part":null,"url":"https://priorityhealth.stylelabs.cloud/api/public/content/2025_Prior_Authorization_Metrics_-__Medicare_H4875.pdf_downloadOriginal?v=0e5cff2f","readOn":"2026-10-07","stdRequests":96478,"stdApproved":88570,"stdDenied":7908,"stdApprovedPct":92,"stdDeniedPct":8,"appeals":1272,"appealApproved":932,"appealApprovedPct":73,"extendedRequests":null,"extendedApproved":0,"extendedApprovedPct":null,"expRequests":4640,"expApproved":4230,"expDenied":410,"expApprovedPct":91,"expDeniedPct":9,"stdAvgHours":50.64,"stdMedianHours":48,"expAvgHours":25.01,"expMedianHours":9.17,"timesAsPosted":"standard 2.11 days mean, 2 days median; expedited 25.01 hours mean, 9.17 hours median","note":"Percentages posted to whole numbers. Extension rows print 0 approved and 0 denied only after an extension, against total requests; number of extended requests not printed. Standard appeals also print 194 denied only after appeal of 1272 (15%). Expedited appeals: 932 approved only after appeal of 1272 (73%), 194 denied (15%). Time units printed once per row ('Days' / 'Hours') between the mean and median columns; applied to both. File also prints approved/denied within 14 days (88,504 / 7,666) and within 72 hours (4,138 / 351). Expedited appeal rows (932 approved / 194 denied of 1,272) are identical to the standard appeal rows - looks like a copy error in the file.","ratePrecision":{"stdApprovedPct":0,"stdDeniedPct":0,"expApprovedPct":0,"expDeniedPct":0,"appealApprovedPct":0}},{"id":"ph-ma-h8379","year":2025,"payer":"Priority Health","program":"ma","report":"H8379 Medicare","part":null,"url":"https://priorityhealth.stylelabs.cloud/api/public/content/2025_Prior_Authorization_Metrics_-__Medicare__H8379.pdf_downloadOriginal?v=ccd28dc1","readOn":"2026-10-07","stdRequests":12695,"stdApproved":11477,"stdDenied":1218,"stdApprovedPct":90,"stdDeniedPct":10,"appeals":207,"appealApproved":142,"appealApprovedPct":69,"extendedRequests":null,"extendedApproved":0,"extendedApprovedPct":null,"expRequests":683,"expApproved":605,"expDenied":78,"expApprovedPct":89,"expDeniedPct":11,"stdAvgHours":56.4,"stdMedianHours":24,"expAvgHours":25.91,"expMedianHours":24,"timesAsPosted":"standard 2.35 days mean, 1 day median; expedited 25.91 hours mean, 24 hours median","note":"Percentages posted to whole numbers. Extension rows print 0 approved and 0 denied only after an extension, against total requests; number of extended requests not printed. Standard appeals also print 36 denied only after appeal of 207 (17%). Expedited appeals: 41 approved only after appeal of 52 (79%), 7 denied (13%). Time units printed once per row ('Days' / 'Hours') between the mean and median columns; applied to both. File also prints approved/denied within 14 days (11,459 / 1,200) and within 72 hours (594 / 64).","ratePrecision":{"stdApprovedPct":0,"stdDeniedPct":0,"expApprovedPct":0,"expDeniedPct":0,"appealApprovedPct":0}},{"id":"ph-mcd","year":2025,"payer":"Priority Health","program":"medicaid-mco","report":"Priority Health Medicaid, Michigan","part":null,"url":"https://priorityhealth.stylelabs.cloud/api/public/content/Prior_Authorization_Metrics_for_Medical_Items_and_Services-021626_v3.pdf_downloadOriginal?v=0f4678fb","readOn":"2026-10-07","stdRequests":78548,"stdApproved":58759,"stdDenied":19789,"stdApprovedPct":75,"stdDeniedPct":25,"appeals":1346,"appealApproved":827,"appealApprovedPct":61,"extendedRequests":null,"extendedApproved":0,"extendedApprovedPct":null,"expRequests":2616,"expApproved":2279,"expDenied":337,"expApprovedPct":87,"expDeniedPct":13,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":"standard 3.43 mean, 2.17 median; expedited 1.99 mean, 0 median","note":"Percentages posted to whole numbers. State not printed in the file (Priority Health is a Michigan plan). Response times printed with no unit; the median column is labeled 'Mean (Middle) Time' (sic). Extension rows print 0 approved/denied only after an extension against total requests; number of extended requests not printed. Standard appeals also print 511 denied only after appeal of 1,346 (38%). Expedited appeals: 32 approved and 32 denied only after appeal of 54 (59% / 41%) - 32/54 = 59.3% and 41% for the same count 32, as printed. File also prints approved/denied within 14 days (58,496 / 19,206) and within 72 hours (2,217 / 311).","ratePrecision":{"stdApprovedPct":0,"stdDeniedPct":0,"expApprovedPct":0,"expDeniedPct":0,"appealApprovedPct":0}},{"id":"scan-ma","year":2025,"payer":"SCAN Health Plan","program":"ma","report":"SCAN Health Plan (all MA contracts)","part":null,"url":"https://scan-q-002.sitecorecontenthub.cloud/api/public/content/SCAN-prior-authorization-data-2025-report-revised-041026?v=882d458e","readOn":"2026-10-07","stdRequests":2070236,"stdApproved":2031943,"stdDenied":38284,"stdApprovedPct":98.15,"stdDeniedPct":1.85,"appeals":5985,"appealApproved":2666,"appealApprovedPct":45,"extendedRequests":null,"extendedApproved":76,"extendedApprovedPct":null,"expRequests":273596,"expApproved":267543,"expDenied":6044,"expApprovedPct":97.79,"expDeniedPct":2.21,"stdAvgHours":72,"stdMedianHours":24,"expAvgHours":24,"expMedianHours":24,"timesAsPosted":"standard 3 days mean, 1 day median; expedited 1 day mean, 1 day median","note":"Single report for SCAN Health Plan; contract ids not named (SCAN runs several MA contracts, incl. California FIDE SNP). Appeals not split by standard/expedited: 2666 approved after appeal of 5,985 (45%). Single extension figure, not split by standard/expedited: 76 approved only after extension 'out of total request' 2,070,227 (<1%); number of extended requests not printed. Standard approved + denied = 2,070,227, 9 short of the printed total 2,070,236 (the extension row uses 2,070,227); expedited approved + denied = 273,587, 9 short of 273,596. The pie chart labels standard denied '1.89%' while the table prints 1.85%.","ratePrecision":{"appealApprovedPct":0}},{"id":"al-allkids","year":2025,"payer":"Blue Cross and Blue Shield of Alabama","program":"chip-mco","report":"ALL Kids (Alabama)","part":null,"url":"https://www.bcbsal.org/web/prior-authorization-metrics-reporting","readOn":"2026-10-07","stdRequests":26098,"stdApproved":25341,"stdDenied":757,"stdApprovedPct":97.1,"stdDeniedPct":2.9,"appeals":8,"appealApproved":0,"appealApprovedPct":0,"extendedRequests":null,"extendedApproved":1,"extendedApprovedPct":0,"expRequests":52,"expApproved":51,"expDenied":1,"expApprovedPct":98.08,"expDeniedPct":1.92,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":"standard 2.98 day(s) mean, 0 day(s) median; expedited 1.08 day(s) mean, 1 day(s) median","note":"Page does not state the reporting year; it says the data cover 'the previous calendar year' (page copyright 2026), so presumed CY2025. Section labeled 'ALL Kids' (Alabama's CHIP); program assigned as chip-mco from the program name, page does not say CHIP. Appeals: 8 appealed of 757 denied (1.06%) -- the appeal rate has no slot. Extended: page prints only approved-after-extension (1) over all standard requests (26,098) = 0.00%; number of extended requests not printed. Expedited approved after extension: 0 of 52 (0.00%) -- no slot. Appeals not split standard/expedited; appeals sit under the standard section."},{"id":"al-qhp","year":2025,"payer":"Blue Cross and Blue Shield of Alabama","program":"qhp","report":"Qualified Health Plan (Alabama)","part":null,"url":"https://www.bcbsal.org/web/prior-authorization-metrics-reporting","readOn":"2026-10-07","stdRequests":80737,"stdApproved":75513,"stdDenied":5224,"stdApprovedPct":93.53,"stdDeniedPct":6.47,"appeals":24,"appealApproved":7,"appealApprovedPct":29.17,"extendedRequests":null,"extendedApproved":46,"extendedApprovedPct":0.06,"expRequests":702,"expApproved":651,"expDenied":51,"expApprovedPct":92.74,"expDeniedPct":7.26,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":"standard 0.9 day(s) mean, 0 day(s) median; expedited 0.86 day(s) mean, 1 day(s) median","note":"Page does not state the reporting year; it says the data cover 'the previous calendar year' (page copyright 2026), so presumed CY2025. Appeals: 24 appealed of 5,224 denied (0.46%) -- the appeal rate has no slot. Extended: page prints only approved-after-extension (46) over all standard requests (80,737) = 0.06%; number of extended requests not printed. Expedited approved after extension: 4 of 702 (0.57%) -- no slot. Expedited median (1 day) exceeds expedited mean (0.86 day) and the expedited median exceeds the standard median (0 days), as printed."},{"id":"la-qhp-lhsic","year":2025,"payer":"Blue Cross and Blue Shield of Louisiana","program":"qhp","report":"LHSIC (Louisiana Health Service & Indemnity Co.) QHP, Louisiana","part":null,"url":"https://www.lablue.com/landing/cmsauth","readOn":"2026-10-07","stdRequests":10856,"stdApproved":10158,"stdDenied":698,"stdApprovedPct":93.57,"stdDeniedPct":6.43,"appeals":87,"appealApproved":25,"appealApprovedPct":29,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":1002,"expApproved":962,"expDenied":40,"expApprovedPct":96.01,"expDeniedPct":3.99,"stdAvgHours":null,"stdMedianHours":0,"expAvgHours":18,"expMedianHours":5,"timesAsPosted":"standard < 1 day mean, 0 days median; expedited 18 hours mean, 5 hours median","note":"Reporting year 2025 (01/01/2025-12/31/2025) stated on the page. Extension metrics (standard and expedited) printed as 'Not applicable'. Appeal approval percentage printed to whole percent. Standard median printed as '0 days**'; footnote attributes it to the auto-approval rate. Appeals figures are for standard requests only; no expedited appeal figures printed. Column header is just 'LHSIC'; expansion of the acronym is not on the page.","ratePrecision":{"appealApprovedPct":0}},{"id":"la-qhp-hmo","year":2025,"payer":"Blue Cross and Blue Shield of Louisiana","program":"qhp","report":"HMO (HMO Louisiana) QHP, Louisiana","part":null,"url":"https://www.lablue.com/landing/cmsauth","readOn":"2026-10-07","stdRequests":62789,"stdApproved":58722,"stdDenied":4067,"stdApprovedPct":93.52,"stdDeniedPct":6.48,"appeals":394,"appealApproved":143,"appealApprovedPct":36,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":4209,"expApproved":4055,"expDenied":154,"expApprovedPct":96.34,"expDeniedPct":3.66,"stdAvgHours":null,"stdMedianHours":0,"expAvgHours":17,"expMedianHours":4,"timesAsPosted":"standard < 1 day mean, 0 days median; expedited 17 hours mean, 4 hours median","note":"Reporting year 2025 (01/01/2025-12/31/2025) stated on the page. Extension metrics (standard and expedited) printed as 'Not applicable'. Appeal approval percentage printed to whole percent. Standard median printed as '0 days**'; footnote attributes it to the auto-approval rate. Appeals figures are for standard requests only; no expedited appeal figures printed. Column header is just 'HMO'; HMO Louisiana, Inc. is named elsewhere on the page as a subsidiary.","ratePrecision":{"appealApprovedPct":0}},{"id":"la-ma-h6453","year":2025,"payer":"Blue Cross and Blue Shield of Louisiana","program":"ma","report":"H6453 Blue Advantage (HMO)","part":null,"url":"https://blueadvantage.lablue.com/cmsauthba","readOn":"2026-10-07","stdRequests":89303,"stdApproved":88405,"stdDenied":898,"stdApprovedPct":98.99,"stdDeniedPct":1.01,"appeals":38,"appealApproved":32,"appealApprovedPct":84.21,"extendedRequests":null,"extendedApproved":27,"extendedApprovedPct":0.03,"expRequests":6851,"expApproved":6762,"expDenied":89,"expApprovedPct":98.69,"expDeniedPct":1.31,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":5,"expMedianHours":1,"timesAsPosted":"standard < 1 day mean, < 1 day median; expedited 5 hours mean, 1 hour median","note":"Reporting year 2025 (01/01/2025-12/31/2025) stated on the page. Extended: page prints only approved-after-extension count with a percentage whose denominator is all standard requests; number of extended requests not printed. Appeals figures are for standard requests only. Expedited extended: count 1 (labeled 'requests for which the timeframe for review was extended'), 0.01% (of 6,851 expedited requests) -- no slot. Page prints expedited 98.69% approved (6,762/6,851) and 1.31% denied (89/6,851); those counts give 98.70% / 1.30%. Kept as printed (raw HTML confirms)."},{"id":"la-ma-h1248","year":2025,"payer":"Blue Cross and Blue Shield of Louisiana","program":"ma","report":"H1248 Blue Advantage (PPO)","part":null,"url":"https://blueadvantage.lablue.com/cmsauthba","readOn":"2026-10-07","stdRequests":32192,"stdApproved":31879,"stdDenied":313,"stdApprovedPct":99.03,"stdDeniedPct":0.97,"appeals":17,"appealApproved":17,"appealApprovedPct":100,"extendedRequests":null,"extendedApproved":16,"extendedApprovedPct":0.05,"expRequests":2952,"expApproved":2937,"expDenied":15,"expApprovedPct":99.49,"expDeniedPct":0.51,"stdAvgHours":24,"stdMedianHours":null,"expAvgHours":5,"expMedianHours":1,"timesAsPosted":"standard 1 day mean, < 1 day median; expedited 5 hours mean, 1 hour median","note":"Reporting year 2025 (01/01/2025-12/31/2025) stated on the page. Extended: page prints only approved-after-extension count with a percentage whose denominator is all standard requests; number of extended requests not printed. Appeals figures are for standard requests only. Expedited extended: count 1 (labeled 'requests for which the timeframe for review was extended'), 0.03% (of 2,952 expedited requests) -- no slot."},{"id":"alignment-ma-h3443","year":2025,"payer":"Alignment Health","program":"ma","report":"H3443 (no plan name printed)","part":null,"url":"https://www.alignmenthealthplan.com/providers/prior-authorization/prior-authorization-for-medical-items-and-services","readOn":"2026-10-07","stdRequests":14282,"stdApproved":13448,"stdDenied":834,"stdApprovedPct":94.16,"stdDeniedPct":5.84,"appeals":43,"appealApproved":32,"appealApprovedPct":74,"extendedRequests":0,"extendedApproved":0,"extendedApprovedPct":null,"expRequests":4204,"expApproved":4061,"expDenied":143,"expApprovedPct":96.6,"expDeniedPct":3.4,"stdAvgHours":51.6,"stdMedianHours":24,"expAvgHours":18.96,"expMedianHours":14.16,"timesAsPosted":"standard 2.15 days mean, 1.00 days median; expedited 0.79 days mean, 0.59 days median","note":"Reporting year '2025' stated in the section heading; page last updated May 21, 2026. Times printed as bare numbers under the column header 'Time in Days'; unit appended from that header. Page footnote: '0' means processed same day. Appeals figures combine standard and expedited requests ('Standard (Non-Urgent) and Expedited (Urgent) Requests Approved After Appeal'); percentage printed to whole percent. Extended percentages printed to whole percent; the 'Out of Total Requests' denominator for extensions is a small number (e.g. 168 for H3815), read as the number of extended requests. Expedited approved after extension: 0 of 0 (0%) -- no slot. Extension rows print '0 0 0%' (zero of zero). The file posts extendedApprovedPct as 0% over zero requests; carried as no rate.","ratePrecision":{"appealApprovedPct":0}},{"id":"alignment-ma-h3815","year":2025,"payer":"Alignment Health","program":"ma","report":"H3815 (no plan name printed)","part":null,"url":"https://www.alignmenthealthplan.com/providers/prior-authorization/prior-authorization-for-medical-items-and-services","readOn":"2026-10-07","stdRequests":837729,"stdApproved":819796,"stdDenied":17933,"stdApprovedPct":97.86,"stdDeniedPct":2.14,"appeals":737,"appealApproved":411,"appealApprovedPct":56,"extendedRequests":168,"extendedApproved":131,"extendedApprovedPct":78,"expRequests":131895,"expApproved":128108,"expDenied":3787,"expApprovedPct":97.13,"expDeniedPct":2.87,"stdAvgHours":45.6,"stdMedianHours":12,"expAvgHours":20.64,"expMedianHours":14.88,"timesAsPosted":"standard 1.90 days mean, 0.50 days median; expedited 0.86 days mean, 0.62 days median","note":"Reporting year '2025' stated in the section heading; page last updated May 21, 2026. Times printed as bare numbers under the column header 'Time in Days'; unit appended from that header. Page footnote: '0' means processed same day. Appeals figures combine standard and expedited requests ('Standard (Non-Urgent) and Expedited (Urgent) Requests Approved After Appeal'); percentage printed to whole percent. Extended percentages printed to whole percent; the 'Out of Total Requests' denominator for extensions is a small number (e.g. 168 for H3815), read as the number of extended requests. Expedited approved after extension: 32 of 45 (71%) -- no slot.","ratePrecision":{"appealApprovedPct":0}},{"id":"alignment-ma-h4961","year":2025,"payer":"Alignment Health","program":"ma","report":"H4961 (no plan name printed)","part":null,"url":"https://www.alignmenthealthplan.com/providers/prior-authorization/prior-authorization-for-medical-items-and-services","readOn":"2026-10-07","stdRequests":5063,"stdApproved":4917,"stdDenied":146,"stdApprovedPct":97.12,"stdDeniedPct":2.88,"appeals":13,"appealApproved":8,"appealApprovedPct":62,"extendedRequests":0,"extendedApproved":0,"extendedApprovedPct":null,"expRequests":1636,"expApproved":1604,"expDenied":32,"expApprovedPct":98.04,"expDeniedPct":1.96,"stdAvgHours":73.44,"stdMedianHours":72,"expAvgHours":24,"expMedianHours":14.88,"timesAsPosted":"standard 3.06 days mean, 3.00 days median; expedited 1.00 days mean, 0.62 days median","note":"Reporting year '2025' stated in the section heading; page last updated May 21, 2026. Times printed as bare numbers under the column header 'Time in Days'; unit appended from that header. Page footnote: '0' means processed same day. Appeals figures combine standard and expedited requests ('Standard (Non-Urgent) and Expedited (Urgent) Requests Approved After Appeal'); percentage printed to whole percent. Extended percentages printed to whole percent; the 'Out of Total Requests' denominator for extensions is a small number (e.g. 168 for H3815), read as the number of extended requests. Expedited approved after extension: 0 of 0 (0%) -- no slot. Extension rows print '0 0 0%' (zero of zero). The file posts extendedApprovedPct as 0% over zero requests; carried as no rate.","ratePrecision":{"appealApprovedPct":0}},{"id":"alignment-ma-h5296","year":2025,"payer":"Alignment Health","program":"ma","report":"H5296 (no plan name printed)","part":null,"url":"https://www.alignmenthealthplan.com/providers/prior-authorization/prior-authorization-for-medical-items-and-services","readOn":"2026-10-07","stdRequests":43675,"stdApproved":42068,"stdDenied":1607,"stdApprovedPct":96.32,"stdDeniedPct":3.68,"appeals":129,"appealApproved":87,"appealApprovedPct":67,"extendedRequests":0,"extendedApproved":0,"extendedApprovedPct":null,"expRequests":12105,"expApproved":11781,"expDenied":324,"expApprovedPct":97.32,"expDeniedPct":2.68,"stdAvgHours":66.72,"stdMedianHours":60,"expAvgHours":18.96,"expMedianHours":13.92,"timesAsPosted":"standard 2.78 days mean, 2.50 days median; expedited 0.79 days mean, 0.58 days median","note":"Reporting year '2025' stated in the section heading; page last updated May 21, 2026. Times printed as bare numbers under the column header 'Time in Days'; unit appended from that header. Page footnote: '0' means processed same day. Appeals figures combine standard and expedited requests ('Standard (Non-Urgent) and Expedited (Urgent) Requests Approved After Appeal'); percentage printed to whole percent. Extended percentages printed to whole percent; the 'Out of Total Requests' denominator for extensions is a small number (e.g. 168 for H3815), read as the number of extended requests. Expedited approved after extension: 0 of 0 (0%) -- no slot. Extension rows print '0 0 0%' (zero of zero). The file posts extendedApprovedPct as 0% over zero requests; carried as no rate.","ratePrecision":{"appealApprovedPct":0}},{"id":"alignment-ma-h5472","year":2025,"payer":"Alignment Health","program":"ma","report":"H5472 (no plan name printed)","part":null,"url":"https://www.alignmenthealthplan.com/providers/prior-authorization/prior-authorization-for-medical-items-and-services","readOn":"2026-10-07","stdRequests":9318,"stdApproved":8977,"stdDenied":341,"stdApprovedPct":96.34,"stdDeniedPct":3.66,"appeals":37,"appealApproved":22,"appealApprovedPct":59,"extendedRequests":0,"extendedApproved":0,"extendedApprovedPct":null,"expRequests":4537,"expApproved":4417,"expDenied":120,"expApprovedPct":97.36,"expDeniedPct":2.64,"stdAvgHours":54.48,"stdMedianHours":24,"expAvgHours":16.56,"expMedianHours":12.72,"timesAsPosted":"standard 2.27 days mean, 1.00 days median; expedited 0.69 days mean, 0.53 days median","note":"Reporting year '2025' stated in the section heading; page last updated May 21, 2026. Times printed as bare numbers under the column header 'Time in Days'; unit appended from that header. Page footnote: '0' means processed same day. Appeals figures combine standard and expedited requests ('Standard (Non-Urgent) and Expedited (Urgent) Requests Approved After Appeal'); percentage printed to whole percent. Extended percentages printed to whole percent; the 'Out of Total Requests' denominator for extensions is a small number (e.g. 168 for H3815), read as the number of extended requests. Expedited approved after extension: 0 of 0 (0%) -- no slot. Extension rows print '0 0 0%' (zero of zero). The file posts extendedApprovedPct as 0% over zero requests; carried as no rate.","ratePrecision":{"appealApprovedPct":0}},{"id":"alignment-ma-h7074","year":2025,"payer":"Alignment Health","program":"ma","report":"H7074 (no plan name printed)","part":null,"url":"https://www.alignmenthealthplan.com/providers/prior-authorization/prior-authorization-for-medical-items-and-services","readOn":"2026-10-07","stdRequests":380,"stdApproved":372,"stdDenied":8,"stdApprovedPct":97.89,"stdDeniedPct":2.11,"appeals":1,"appealApproved":1,"appealApprovedPct":100,"extendedRequests":0,"extendedApproved":0,"extendedApprovedPct":null,"expRequests":99,"expApproved":98,"expDenied":1,"expApprovedPct":98.99,"expDeniedPct":1.01,"stdAvgHours":0.96,"stdMedianHours":0,"expAvgHours":0.48,"expMedianHours":0,"timesAsPosted":"standard 0.04 days mean, 0.00 days median; expedited 0.02 days mean, 0.00 days median","note":"Reporting year '2025' stated in the section heading; page last updated May 21, 2026. Times printed as bare numbers under the column header 'Time in Days'; unit appended from that header. Page footnote: '0' means processed same day. Appeals figures combine standard and expedited requests ('Standard (Non-Urgent) and Expedited (Urgent) Requests Approved After Appeal'); percentage printed to whole percent. Extended percentages printed to whole percent; the 'Out of Total Requests' denominator for extensions is a small number (e.g. 168 for H3815), read as the number of extended requests. Expedited approved after extension: 0 of 0 (0%) -- no slot. Extension rows print '0 0 0%' (zero of zero). The file posts extendedApprovedPct as 0% over zero requests; carried as no rate."},{"id":"alignment-ma-h8832","year":2025,"payer":"Alignment Health","program":"ma","report":"H8832 (no plan name printed)","part":null,"url":"https://www.alignmenthealthplan.com/providers/prior-authorization/prior-authorization-for-medical-items-and-services","readOn":"2026-10-07","stdRequests":4044,"stdApproved":3927,"stdDenied":117,"stdApprovedPct":97.11,"stdDeniedPct":2.89,"appeals":12,"appealApproved":9,"appealApprovedPct":75,"extendedRequests":0,"extendedApproved":0,"extendedApprovedPct":null,"expRequests":1601,"expApproved":1567,"expDenied":34,"expApprovedPct":97.88,"expDeniedPct":2.12,"stdAvgHours":44.64,"stdMedianHours":18,"expAvgHours":21.36,"expMedianHours":13.68,"timesAsPosted":"standard 1.86 days mean, 0.75 days median; expedited 0.89 days mean, 0.57 days median","note":"Reporting year '2025' stated in the section heading; page last updated May 21, 2026. Times printed as bare numbers under the column header 'Time in Days'; unit appended from that header. Page footnote: '0' means processed same day. Appeals figures combine standard and expedited requests ('Standard (Non-Urgent) and Expedited (Urgent) Requests Approved After Appeal'); percentage printed to whole percent. Extended percentages printed to whole percent; the 'Out of Total Requests' denominator for extensions is a small number (e.g. 168 for H3815), read as the number of extended requests. Expedited approved after extension: 0 of 0 (0%) -- no slot. Extension rows print '0 0 0%' (zero of zero). The file posts extendedApprovedPct as 0% over zero requests; carried as no rate."},{"id":"emblem-ma-h3330","year":2025,"payer":"EmblemHealth","program":"ma","report":"EmblemHealth Medicare H3330","part":null,"url":"https://www.emblemhealth.com/providers/clinical-corner/um-and-medical-management/pre-authorization-list/preauthorization-metrics","readOn":"2026-10-07","stdRequests":73246,"stdApproved":67575,"stdDenied":5671,"stdApprovedPct":92.3,"stdDeniedPct":7.7,"appeals":null,"appealApproved":353,"appealApprovedPct":0.5,"extendedRequests":null,"extendedApproved":51,"extendedApprovedPct":0.1,"expRequests":2958,"expApproved":2498,"expDenied":460,"expApprovedPct":84.4,"expDeniedPct":15.6,"stdAvgHours":31.2,"stdMedianHours":408,"expAvgHours":9.6,"expMedianHours":108,"timesAsPosted":"standard 1.3 days mean, 17.0 days median; expedited 0.4 days mean, 4.5 days median","note":"'Reporting Period: 2025' stated on the page; last updated 3/31/2026. Median times exceed mean times in every row as printed (standard mean 1.3 days, median 17.0 days; expedited mean 0.4 days, median 4.5 days) -- looks inconsistent, possibly units differ (e.g. hours) or columns swapped; copied as printed. Appeals received not printed; 'Request approved only after appeal' 353 is shown out of all standard requests (73246) = 0.5%, so appealApprovedPct uses all standard requests as denominator, not appeals. Extended: 'approved only after time for review was extended' 51 out of all standard requests (73246) = 0.1%; number of extended requests not printed. Expedited approved after extension: 17 of 2958 (0.6%); expedited approved after appeal: 20 of 2958 (0.7%) -- no slots. Percentages posted to one decimal place (some to two). No plan name beyond 'EmblemHealth Medicare' and contract ID printed. The approved-after-appeal rate is out of all standard requests, not appeals, so it is left out of the market summary.","notPooled":["appealApprovedPct"]},{"id":"emblem-ma-h5991","year":2025,"payer":"EmblemHealth","program":"ma","report":"EmblemHealth Medicare H5991","part":null,"url":"https://www.emblemhealth.com/providers/clinical-corner/um-and-medical-management/pre-authorization-list/preauthorization-metrics","readOn":"2026-10-07","stdRequests":5009,"stdApproved":4309,"stdDenied":700,"stdApprovedPct":86,"stdDeniedPct":14,"appeals":null,"appealApproved":50,"appealApprovedPct":1,"extendedRequests":null,"extendedApproved":4,"extendedApprovedPct":0.1,"expRequests":154,"expApproved":126,"expDenied":28,"expApprovedPct":81.8,"expDeniedPct":18.2,"stdAvgHours":45.6,"stdMedianHours":360,"expAvgHours":14.4,"expMedianHours":72,"timesAsPosted":"standard 1.9 days mean, 15.0 days median; expedited 0.6 days mean, 3.0 days median","note":"'Reporting Period: 2025' stated on the page; last updated 3/31/2026. Median times exceed mean times in every row as printed (standard mean 1.9 days, median 15.0 days; expedited mean 0.6 days, median 3.0 days) -- looks inconsistent, possibly units differ (e.g. hours) or columns swapped; copied as printed. Appeals received not printed; 'Request approved only after appeal' 50 is shown out of all standard requests (5009) = 1.0%, so appealApprovedPct uses all standard requests as denominator, not appeals. Extended: 'approved only after time for review was extended' 4 out of all standard requests (5009) = 0.1%; number of extended requests not printed. Expedited approved after extension: 4 of 154 (2.6%); expedited approved after appeal: 0 of 154 (0.0%) -- no slots. Percentages posted to one decimal place (some to two). No plan name beyond 'EmblemHealth Medicare' and contract ID printed. The approved-after-appeal rate is out of all standard requests, not appeals, so it is left out of the market summary.","notPooled":["appealApprovedPct"]},{"id":"emblem-ma-h5228","year":2025,"payer":"EmblemHealth","program":"ma","report":"EmblemHealth Medicare H5228","part":null,"url":"https://www.emblemhealth.com/providers/clinical-corner/um-and-medical-management/pre-authorization-list/preauthorization-metrics","readOn":"2026-10-07","stdRequests":29,"stdApproved":25,"stdDenied":4,"stdApprovedPct":86.2,"stdDeniedPct":13.8,"appeals":null,"appealApproved":0,"appealApprovedPct":0,"extendedRequests":null,"extendedApproved":0,"extendedApprovedPct":0,"expRequests":2,"expApproved":2,"expDenied":0,"expApprovedPct":100,"expDeniedPct":0,"stdAvgHours":50.4,"stdMedianHours":132,"expAvgHours":0,"expMedianHours":0,"timesAsPosted":"standard 2.1 days mean, 5.5 days median; expedited 0.0 days mean, 0.0 days median","note":"'Reporting Period: 2025' stated on the page; last updated 3/31/2026. Median times exceed mean times in every row as printed (standard mean 2.1 days, median 5.5 days; expedited mean 0.0 days, median 0.0 days) -- looks inconsistent, possibly units differ (e.g. hours) or columns swapped; copied as printed. Appeals received not printed; 'Request approved only after appeal' 0 is shown out of all standard requests (29) = 0.0%, so appealApprovedPct uses all standard requests as denominator, not appeals. Extended: 'approved only after time for review was extended' 0 out of all standard requests (29) = 0.0%; number of extended requests not printed. Expedited approved after extension: 0 of 2 (0.00%); expedited approved after appeal: 0 of 2 (0.0%) -- no slots. Percentages posted to one decimal place (some to two). Expedited extension percentage printed as '0.00%' while sibling rows use one decimal. No plan name beyond 'EmblemHealth Medicare' and contract ID printed. The approved-after-appeal rate is out of all standard requests, not appeals, so it is left out of the market summary.","notPooled":["appealApprovedPct"]},{"id":"emblem-chip-chplus","year":2025,"payer":"EmblemHealth","program":"chip-mco","report":"EmblemHealth CHPlus (New York)","part":null,"url":"https://www.emblemhealth.com/providers/clinical-corner/um-and-medical-management/pre-authorization-list/preauthorization-metrics","readOn":"2026-10-07","stdRequests":6070,"stdApproved":4986,"stdDenied":1084,"stdApprovedPct":82.1,"stdDeniedPct":17.9,"appeals":null,"appealApproved":53,"appealApprovedPct":0.9,"extendedRequests":null,"extendedApproved":3,"extendedApprovedPct":0.05,"expRequests":122,"expApproved":101,"expDenied":21,"expApprovedPct":82.8,"expDeniedPct":17.2,"stdAvgHours":50.4,"stdMedianHours":540,"expAvgHours":4.8,"expMedianHours":36,"timesAsPosted":"standard 2.1 days mean, 22.5 days median; expedited 0.2 days mean, 1.5 days median","note":"'Reporting Period: 2025' stated on the page; last updated 3/31/2026. Median times exceed mean times in every row as printed (standard mean 2.1 days, median 22.5 days; expedited mean 0.2 days, median 1.5 days) -- looks inconsistent, possibly units differ (e.g. hours) or columns swapped; copied as printed. Appeals received not printed; 'Request approved only after appeal' 53 is shown out of all standard requests (6070) = 0.9%, so appealApprovedPct uses all standard requests as denominator, not appeals. Extended: 'approved only after time for review was extended' 3 out of all standard requests (6070) = 0.05%; number of extended requests not printed. Expedited approved after extension: 0 of 122 (0.0%); expedited approved after appeal: 1 of 122 (0.8%) -- no slots. Percentages posted to one decimal place (some to two). CHPlus is New York's Child Health Plus (CHIP); program assigned from the plan name. The approved-after-appeal rate is out of all standard requests, not appeals, so it is left out of the market summary.","notPooled":["appealApprovedPct"]},{"id":"emblem-medicaid-harp","year":2025,"payer":"EmblemHealth","program":"medicaid-mco","report":"EmblemHealth Medicaid and HARP (New York)","part":null,"url":"https://www.emblemhealth.com/providers/clinical-corner/um-and-medical-management/pre-authorization-list/preauthorization-metrics","readOn":"2026-10-07","stdRequests":115230,"stdApproved":89358,"stdDenied":25872,"stdApprovedPct":77.5,"stdDeniedPct":22.5,"appeals":null,"appealApproved":546,"appealApprovedPct":0.5,"extendedRequests":null,"extendedApproved":196,"extendedApprovedPct":0.2,"expRequests":5302,"expApproved":4574,"expDenied":728,"expApprovedPct":86.3,"expDeniedPct":13.7,"stdAvgHours":50.4,"stdMedianHours":1368,"expAvgHours":12,"expMedianHours":264,"timesAsPosted":"standard 2.1 days mean, 57.0 days median; expedited 0.5 days mean, 11.0 days median","note":"'Reporting Period: 2025' stated on the page; last updated 3/31/2026. Median times exceed mean times in every row as printed (standard mean 2.1 days, median 57.0 days; expedited mean 0.5 days, median 11.0 days) -- looks inconsistent, possibly units differ (e.g. hours) or columns swapped; copied as printed. Appeals received not printed; 'Request approved only after appeal' 546 is shown out of all standard requests (115230) = 0.5%, so appealApprovedPct uses all standard requests as denominator, not appeals. Extended: 'approved only after time for review was extended' 196 out of all standard requests (115230) = 0.2%; number of extended requests not printed. Expedited approved after extension: 12 of 5302 (0.2%); expedited approved after appeal: 21 of 5302 (0.4%) -- no slots. Percentages posted to one decimal place (some to two). Medicaid and HARP (Health and Recovery Plan) reported together as one figure set. The approved-after-appeal rate is out of all standard requests, not appeals, so it is left out of the market summary.","notPooled":["appealApprovedPct"]},{"id":"bsc-medicaid-promise","year":2025,"payer":"Blue Shield of California","program":"medicaid-mco","report":"Blue Shield of California Promise Health Plan, Medi-Cal (CA)","part":null,"url":"https://cloud-web.blueshieldca.com/content/dam/bsca/en/promise/docs/2025/Prior-Auth-Metrics-Promise-2025.pdf","readOn":"2026-10-07","stdRequests":892009,"stdApproved":886006,"stdDenied":6003,"stdApprovedPct":99,"stdDeniedPct":1,"appeals":392,"appealApproved":90,"appealApprovedPct":23,"extendedRequests":1229,"extendedApproved":1058,"extendedApprovedPct":86,"expRequests":113125,"expApproved":111918,"expDenied":1207,"expApprovedPct":99,"expDeniedPct":1,"stdAvgHours":24,"stdMedianHours":24,"expAvgHours":5,"expMedianHours":1,"timesAsPosted":"standard 1 day mean, 1 day median (whole calendar days); expedited 5 hours mean, 1 hour median","note":"Counts with whole percentages. Expedited requests whose review was extended: 144 approved of 158 (91%); expedited appeals: 26 approved of 85 (31%). Covers Los Angeles County (contracted with L.A. Care) and San Diego County together.","ratePrecision":{"stdApprovedPct":0,"stdDeniedPct":0,"expApprovedPct":0,"expDeniedPct":0,"appealApprovedPct":0,"extendedApprovedPct":0}},{"id":"bcbsnc-qhp","year":2025,"payer":"Blue Cross and Blue Shield of North Carolina","program":"qhp","report":"Blue Cross NC Affordable Care Act plans","part":null,"url":"https://www.bluecrossnc.com/providers/prior-authorization/metrics","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":82.46,"stdDeniedPct":17.54,"appeals":null,"appealApproved":null,"appealApprovedPct":43.14,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":88.2,"expDeniedPct":11.8,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":34.49,"expMedianHours":20.47,"timesAsPosted":"standard 2.16 days mean, 1 day median; expedited 34.49 hours mean, 20.47 hours median","note":"Percentages only, no counts, on a page that renders its tables by script (read in a browser). Standard times are in business days for the ACA plans, so they are kept as posted and not converted to hours. The extended-review row prints \"0\" with no percent sign; carried as no rate."},{"id":"bcbsnc-ma-ppo","year":2025,"payer":"Blue Cross and Blue Shield of North Carolina","program":"ma","report":"Blue Medicare Advantage (PPO)","part":null,"url":"https://www.bluecrossnc.com/providers/prior-authorization/metrics","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":97.02,"stdDeniedPct":2.98,"appeals":null,"appealApproved":null,"appealApprovedPct":77.07,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":97.17,"expDeniedPct":2.83,"stdAvgHours":96,"stdMedianHours":48,"expAvgHours":16.07,"expMedianHours":8.62,"timesAsPosted":"standard 4 days mean, 2 days median; expedited 16.07 hours mean, 8.62 hours median","note":"Percentages only, no counts, on a page that renders its tables by script (read in a browser). The extended-review rate is posted as N/A. The expedited mean, 16.07 hours, is the same for three Medicare products, as posted."},{"id":"bcbsnc-ma-hmo","year":2025,"payer":"Blue Cross and Blue Shield of North Carolina","program":"ma","report":"Blue Medicare Advantage (HMO)","part":null,"url":"https://www.bluecrossnc.com/providers/prior-authorization/metrics","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":97.03,"stdDeniedPct":2.97,"appeals":null,"appealApproved":null,"appealApprovedPct":72.69,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":95.87,"expDeniedPct":4.13,"stdAvgHours":120,"stdMedianHours":48,"expAvgHours":16.07,"expMedianHours":8.42,"timesAsPosted":"standard 5 days mean, 2 days median; expedited 16.07 hours mean, 8.42 hours median","note":"Percentages only, no counts, on a page that renders its tables by script (read in a browser). The extended-review rate is posted as N/A. The expedited mean, 16.07 hours, is the same for three Medicare products, as posted."},{"id":"bcbsnc-ma-experience","year":2025,"payer":"Blue Cross and Blue Shield of North Carolina","program":"ma","report":"Experience Health Medicare Advantage (HMO)","part":null,"url":"https://www.bluecrossnc.com/providers/prior-authorization/metrics","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":96.08,"stdDeniedPct":3.92,"appeals":null,"appealApproved":null,"appealApprovedPct":54.17,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":90.18,"expDeniedPct":9.82,"stdAvgHours":120,"stdMedianHours":72,"expAvgHours":16.07,"expMedianHours":8.3,"timesAsPosted":"standard 5 days mean, 3 days median; expedited 16.07 hours mean, 8.30 hours median","note":"Percentages only, no counts, on a page that renders its tables by script (read in a browser). The extended-review rate is posted as N/A. The expedited mean, 16.07 hours, is the same for three Medicare products, as posted."},{"id":"bcbsnc-ma-dsnp","year":2025,"payer":"Blue Cross and Blue Shield of North Carolina","program":"ma","report":"Healthy Blue + Medicare (HMO-POS D-SNP)","part":null,"url":"https://www.bluecrossnc.com/providers/prior-authorization/metrics","readOn":"2026-10-07","stdRequests":null,"stdApproved":null,"stdDenied":null,"stdApprovedPct":97.3,"stdDeniedPct":2.7,"appeals":null,"appealApproved":null,"appealApprovedPct":86.1,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":null,"expApproved":null,"expDenied":null,"expApprovedPct":98.5,"expDeniedPct":1.5,"stdAvgHours":48,"stdMedianHours":24,"expAvgHours":24,"expMedianHours":24,"timesAsPosted":"standard 2 days mean, 1 day median; expedited 24 hours mean, 24 hours median","note":"Percentages only, no counts, on a page that renders its tables by script (read in a browser). The extended-review rate is posted as N/A."},{"id":"bcbsmn-h5959-007","year":2025,"payer":"Blue Cross and Blue Shield of Minnesota","program":"ma","report":"H5959","part":"H5959-007 Blue Cross Medicare Advantage Choice MA Only Metro & West","url":"https://bluecrossmn.widen.net/content/ur5toniz6n/original/2025-interoperability-report.pdf","readOn":"2026-10-07","stdRequests":1,"stdApproved":1,"stdDenied":0,"stdApprovedPct":100,"stdDeniedPct":0,"appeals":0,"appealApproved":0,"appealApprovedPct":null,"extendedRequests":1,"extendedApproved":0,"extendedApprovedPct":0,"expRequests":0,"expApproved":0,"expDenied":0,"expApprovedPct":null,"expDeniedPct":null,"stdAvgHours":5.28,"stdMedianHours":5.28,"expAvgHours":0,"expMedianHours":0,"timesAsPosted":"standard 0.22 day(s) mean, 0.22 day(s) median; expedited 0.00 day(s) mean, 0.00 day(s) median","note":"Blue Cross MN posts its report by plan benefit package, not by contract, so each package is its own row and none is pooled in the market summary (a contract would otherwise count once per package). Counts and percentages; times in days to two decimals. Expedited requests whose review was extended: none.","notPooled":["stdApprovedPct","stdDeniedPct","appealApprovedPct","expApprovedPct","expDeniedPct"]},{"id":"bcbsmn-h5959-009","year":2025,"payer":"Blue Cross and Blue Shield of Minnesota","program":"ma","report":"H5959","part":"H5959-009 Blue Cross Medicare Advantage Choice South","url":"https://bluecrossmn.widen.net/content/ur5toniz6n/original/2025-interoperability-report.pdf","readOn":"2026-10-07","stdRequests":4033,"stdApproved":3773,"stdDenied":260,"stdApprovedPct":93.55,"stdDeniedPct":6.45,"appeals":25,"appealApproved":7,"appealApprovedPct":28,"extendedRequests":4033,"extendedApproved":0,"extendedApprovedPct":0,"expRequests":204,"expApproved":200,"expDenied":4,"expApprovedPct":98.04,"expDeniedPct":1.96,"stdAvgHours":44.4,"stdMedianHours":4.08,"expAvgHours":5.76,"expMedianHours":0.24,"timesAsPosted":"standard 1.85 day(s) mean, 0.17 day(s) median; expedited 0.24 day(s) mean, 0.01 day(s) median","note":"Blue Cross MN posts its report by plan benefit package, not by contract, so each package is its own row and none is pooled in the market summary (a contract would otherwise count once per package). Counts and percentages; times in days to two decimals. Expedited requests whose review was extended: 0 approved of 204.","notPooled":["stdApprovedPct","stdDeniedPct","appealApprovedPct","expApprovedPct","expDeniedPct"]},{"id":"bcbsmn-h5959-010","year":2025,"payer":"Blue Cross and Blue Shield of Minnesota","program":"ma","report":"H5959","part":"H5959-010 Blue Cross Medicare Advantage Complete Metro & West","url":"https://bluecrossmn.widen.net/content/ur5toniz6n/original/2025-interoperability-report.pdf","readOn":"2026-10-07","stdRequests":20062,"stdApproved":19223,"stdDenied":839,"stdApprovedPct":95.82,"stdDeniedPct":4.18,"appeals":94,"appealApproved":31,"appealApprovedPct":32.98,"extendedRequests":20062,"extendedApproved":0,"extendedApprovedPct":0,"expRequests":603,"expApproved":573,"expDenied":30,"expApprovedPct":95.02,"expDeniedPct":4.98,"stdAvgHours":38.88,"stdMedianHours":1.2,"expAvgHours":5.28,"expMedianHours":0,"timesAsPosted":"standard 1.62 day(s) mean, 0.05 day(s) median; expedited 0.22 day(s) mean, 0.00 day(s) median","note":"Blue Cross MN posts its report by plan benefit package, not by contract, so each package is its own row and none is pooled in the market summary (a contract would otherwise count once per package). Counts and percentages; times in days to two decimals. Expedited requests whose review was extended: 0 approved of 603.","notPooled":["stdApprovedPct","stdDeniedPct","appealApprovedPct","expApprovedPct","expDeniedPct"]},{"id":"bcbsmn-h5959-011","year":2025,"payer":"Blue Cross and Blue Shield of Minnesota","program":"ma","report":"H5959","part":"H5959-011 Blue Cross Medicare Advantage Complete South","url":"https://bluecrossmn.widen.net/content/ur5toniz6n/original/2025-interoperability-report.pdf","readOn":"2026-10-07","stdRequests":862,"stdApproved":807,"stdDenied":55,"stdApprovedPct":93.62,"stdDeniedPct":6.38,"appeals":6,"appealApproved":3,"appealApprovedPct":50,"extendedRequests":862,"extendedApproved":0,"extendedApprovedPct":0,"expRequests":41,"expApproved":38,"expDenied":3,"expApprovedPct":92.68,"expDeniedPct":7.32,"stdAvgHours":45.12,"stdMedianHours":4.08,"expAvgHours":5.52,"expMedianHours":0.48,"timesAsPosted":"standard 1.88 day(s) mean, 0.17 day(s) median; expedited 0.23 day(s) mean, 0.02 day(s) median","note":"Blue Cross MN posts its report by plan benefit package, not by contract, so each package is its own row and none is pooled in the market summary (a contract would otherwise count once per package). Counts and percentages; times in days to two decimals. Expedited requests whose review was extended: 0 approved of 41.","notPooled":["stdApprovedPct","stdDeniedPct","appealApprovedPct","expApprovedPct","expDeniedPct"]},{"id":"bcbsmn-h5959-012","year":2025,"payer":"Blue Cross and Blue Shield of Minnesota","program":"ma","report":"H5959","part":"H5959-012 Blue Cross Medicare Core South","url":"https://bluecrossmn.widen.net/content/ur5toniz6n/original/2025-interoperability-report.pdf","readOn":"2026-10-07","stdRequests":641,"stdApproved":604,"stdDenied":37,"stdApprovedPct":94.23,"stdDeniedPct":5.77,"appeals":4,"appealApproved":2,"appealApprovedPct":50,"extendedRequests":641,"extendedApproved":0,"extendedApprovedPct":0,"expRequests":38,"expApproved":36,"expDenied":2,"expApprovedPct":94.74,"expDeniedPct":5.26,"stdAvgHours":39.12,"stdMedianHours":4.08,"expAvgHours":5.28,"expMedianHours":0.72,"timesAsPosted":"standard 1.63 day(s) mean, 0.17 day(s) median; expedited 0.22 day(s) mean, 0.03 day(s) median","note":"Blue Cross MN posts its report by plan benefit package, not by contract, so each package is its own row and none is pooled in the market summary (a contract would otherwise count once per package). Counts and percentages; times in days to two decimals. Expedited requests whose review was extended: 0 approved of 38.","notPooled":["stdApprovedPct","stdDeniedPct","appealApprovedPct","expApprovedPct","expDeniedPct"]},{"id":"bcbsmn-h5959-013","year":2025,"payer":"Blue Cross and Blue Shield of Minnesota","program":"ma","report":"H5959","part":"H5959-013 Blue Cross Medicare Core Metro & West","url":"https://bluecrossmn.widen.net/content/ur5toniz6n/original/2025-interoperability-report.pdf","readOn":"2026-10-07","stdRequests":18817,"stdApproved":17939,"stdDenied":878,"stdApprovedPct":95.33,"stdDeniedPct":4.67,"appeals":92,"appealApproved":39,"appealApprovedPct":42.39,"extendedRequests":18817,"extendedApproved":0,"extendedApprovedPct":0,"expRequests":587,"expApproved":558,"expDenied":29,"expApprovedPct":95.06,"expDeniedPct":4.94,"stdAvgHours":38.4,"stdMedianHours":0,"expAvgHours":6,"expMedianHours":0,"timesAsPosted":"standard 1.60 day(s) mean, 0.00 day(s) median; expedited 0.25 day(s) mean, 0.00 day(s) median","note":"Blue Cross MN posts its report by plan benefit package, not by contract, so each package is its own row and none is pooled in the market summary (a contract would otherwise count once per package). Counts and percentages; times in days to two decimals. Expedited requests whose review was extended: 0 approved of 587.","notPooled":["stdApprovedPct","stdDeniedPct","appealApprovedPct","expApprovedPct","expDeniedPct"]},{"id":"bcbsmn-h5959-014","year":2025,"payer":"Blue Cross and Blue Shield of Minnesota","program":"ma","report":"H5959","part":"H5959-014 Blue Cross Medicare Choice Metro & West","url":"https://bluecrossmn.widen.net/content/ur5toniz6n/original/2025-interoperability-report.pdf","readOn":"2026-10-07","stdRequests":118617,"stdApproved":113775,"stdDenied":4842,"stdApprovedPct":95.92,"stdDeniedPct":4.08,"appeals":538,"appealApproved":229,"appealApprovedPct":42.57,"extendedRequests":118617,"extendedApproved":0,"extendedApprovedPct":0,"expRequests":3583,"expApproved":3454,"expDenied":129,"expApprovedPct":96.4,"expDeniedPct":3.6,"stdAvgHours":37.92,"stdMedianHours":0,"expAvgHours":5.76,"expMedianHours":0,"timesAsPosted":"standard 1.58 day(s) mean, 0.00 day(s) median; expedited 0.24 day(s) mean, 0.00 day(s) median","note":"Blue Cross MN posts its report by plan benefit package, not by contract, so each package is its own row and none is pooled in the market summary (a contract would otherwise count once per package). Counts and percentages; times in days to two decimals. Expedited requests whose review was extended: 0 approved of 3,583.","notPooled":["stdApprovedPct","stdDeniedPct","appealApprovedPct","expApprovedPct","expDeniedPct"]},{"id":"bcbsmn-h5959-015","year":2025,"payer":"Blue Cross and Blue Shield of Minnesota","program":"ma","report":"H5959","part":"H5959-015 Blue Cross Medicare Comfort Metro","url":"https://bluecrossmn.widen.net/content/ur5toniz6n/original/2025-interoperability-report.pdf","readOn":"2026-10-07","stdRequests":14142,"stdApproved":13567,"stdDenied":575,"stdApprovedPct":95.93,"stdDeniedPct":4.07,"appeals":58,"appealApproved":22,"appealApprovedPct":37.93,"extendedRequests":14142,"extendedApproved":0,"extendedApprovedPct":0,"expRequests":432,"expApproved":424,"expDenied":8,"expApprovedPct":98.15,"expDeniedPct":1.85,"stdAvgHours":36,"stdMedianHours":0,"expAvgHours":4.56,"expMedianHours":0,"timesAsPosted":"standard 1.50 day(s) mean, 0.00 day(s) median; expedited 0.19 day(s) mean, 0.00 day(s) median","note":"Blue Cross MN posts its report by plan benefit package, not by contract, so each package is its own row and none is pooled in the market summary (a contract would otherwise count once per package). Counts and percentages; times in days to two decimals. Expedited requests whose review was extended: 0 approved of 432.","notPooled":["stdApprovedPct","stdDeniedPct","appealApprovedPct","expApprovedPct","expDeniedPct"]},{"id":"bcbsmn-h5959-016","year":2025,"payer":"Blue Cross and Blue Shield of Minnesota","program":"ma","report":"H5959","part":"H5959-016 Blue Cross Medicare Comfort West","url":"https://bluecrossmn.widen.net/content/ur5toniz6n/original/2025-interoperability-report.pdf","readOn":"2026-10-07","stdRequests":6137,"stdApproved":5870,"stdDenied":267,"stdApprovedPct":95.65,"stdDeniedPct":4.35,"appeals":21,"appealApproved":13,"appealApprovedPct":61.9,"extendedRequests":6137,"extendedApproved":0,"extendedApprovedPct":0,"expRequests":199,"expApproved":196,"expDenied":3,"expApprovedPct":98.49,"expDeniedPct":1.51,"stdAvgHours":39.6,"stdMedianHours":1.68,"expAvgHours":5.28,"expMedianHours":0,"timesAsPosted":"standard 1.65 day(s) mean, 0.07 day(s) median; expedited 0.22 day(s) mean, 0.00 day(s) median","note":"Blue Cross MN posts its report by plan benefit package, not by contract, so each package is its own row and none is pooled in the market summary (a contract would otherwise count once per package). Counts and percentages; times in days to two decimals. Expedited requests whose review was extended: 0 approved of 199.","notPooled":["stdApprovedPct","stdDeniedPct","appealApprovedPct","expApprovedPct","expDeniedPct"]},{"id":"bcbsmn-h5959-018","year":2025,"payer":"Blue Cross and Blue Shield of Minnesota","program":"ma","report":"H5959","part":"H5959-018 Blue Cross Medicare Advantage Freedom Blue MA Only","url":"https://bluecrossmn.widen.net/content/ur5toniz6n/original/2025-interoperability-report.pdf","readOn":"2026-10-07","stdRequests":7618,"stdApproved":7283,"stdDenied":335,"stdApprovedPct":95.6,"stdDeniedPct":4.4,"appeals":25,"appealApproved":13,"appealApprovedPct":52,"extendedRequests":7618,"extendedApproved":0,"extendedApprovedPct":0,"expRequests":294,"expApproved":283,"expDenied":11,"expApprovedPct":96.26,"expDeniedPct":3.74,"stdAvgHours":36.72,"stdMedianHours":0.48,"expAvgHours":5.04,"expMedianHours":0,"timesAsPosted":"standard 1.53 day(s) mean, 0.02 day(s) median; expedited 0.21 day(s) mean, 0.00 day(s) median","note":"Blue Cross MN posts its report by plan benefit package, not by contract, so each package is its own row and none is pooled in the market summary (a contract would otherwise count once per package). Counts and percentages; times in days to two decimals. Expedited requests whose review was extended: 0 approved of 294.","notPooled":["stdApprovedPct","stdDeniedPct","appealApprovedPct","expApprovedPct","expDeniedPct"]},{"id":"bcbsmn-h5959-801","year":2025,"payer":"Blue Cross and Blue Shield of Minnesota","program":"ma","report":"H5959","part":"H5959-801 Group Medicare Advantage Classic, Select & Premier","url":"https://bluecrossmn.widen.net/content/ur5toniz6n/original/2025-interoperability-report.pdf","readOn":"2026-10-07","stdRequests":1880,"stdApproved":1783,"stdDenied":97,"stdApprovedPct":94.84,"stdDeniedPct":5.16,"appeals":7,"appealApproved":1,"appealApprovedPct":14.29,"extendedRequests":1880,"extendedApproved":0,"extendedApprovedPct":0,"expRequests":49,"expApproved":47,"expDenied":2,"expApprovedPct":95.92,"expDeniedPct":4.08,"stdAvgHours":36.72,"stdMedianHours":4.08,"expAvgHours":6.48,"expMedianHours":0.24,"timesAsPosted":"standard 1.53 day(s) mean, 0.17 day(s) median; expedited 0.27 day(s) mean, 0.01 day(s) median","note":"Blue Cross MN posts its report by plan benefit package, not by contract, so each package is its own row and none is pooled in the market summary (a contract would otherwise count once per package). Counts and percentages; times in days to two decimals. Expedited requests whose review was extended: 0 approved of 49.","notPooled":["stdApprovedPct","stdDeniedPct","appealApprovedPct","expApprovedPct","expDeniedPct"]},{"id":"bcbsmn-h5959-807","year":2025,"payer":"Blue Cross and Blue Shield of Minnesota","program":"ma","report":"H5959","part":"H5959-807 Group Medicare Advantage Standard, Plus, Value & Elite","url":"https://bluecrossmn.widen.net/content/ur5toniz6n/original/2025-interoperability-report.pdf","readOn":"2026-10-07","stdRequests":3009,"stdApproved":2845,"stdDenied":164,"stdApprovedPct":94.55,"stdDeniedPct":5.45,"appeals":12,"appealApproved":3,"appealApprovedPct":25,"extendedRequests":3009,"extendedApproved":0,"extendedApprovedPct":0,"expRequests":86,"expApproved":82,"expDenied":4,"expApprovedPct":95.35,"expDeniedPct":4.65,"stdAvgHours":34.8,"stdMedianHours":0,"expAvgHours":5.04,"expMedianHours":0,"timesAsPosted":"standard 1.45 day(s) mean, 0.00 day(s) median; expedited 0.21 day(s) mean, 0.00 day(s) median","note":"Blue Cross MN posts its report by plan benefit package, not by contract, so each package is its own row and none is pooled in the market summary (a contract would otherwise count once per package). Counts and percentages; times in days to two decimals. Expedited requests whose review was extended: 0 approved of 86.","notPooled":["stdApprovedPct","stdDeniedPct","appealApprovedPct","expApprovedPct","expDeniedPct"]},{"id":"bcbsmn-h5959-808","year":2025,"payer":"Blue Cross and Blue Shield of Minnesota","program":"ma","report":"H5959","part":"H5959-808 Group Medicare Advantage Classic","url":"https://bluecrossmn.widen.net/content/ur5toniz6n/original/2025-interoperability-report.pdf","readOn":"2026-10-07","stdRequests":27,"stdApproved":27,"stdDenied":0,"stdApprovedPct":100,"stdDeniedPct":0,"appeals":1,"appealApproved":1,"appealApprovedPct":100,"extendedRequests":27,"extendedApproved":0,"extendedApprovedPct":0,"expRequests":0,"expApproved":0,"expDenied":0,"expApprovedPct":null,"expDeniedPct":null,"stdAvgHours":41.04,"stdMedianHours":4.08,"expAvgHours":0,"expMedianHours":0,"timesAsPosted":"standard 1.71 day(s) mean, 0.17 day(s) median; expedited 0.00 day(s) mean, 0.00 day(s) median","note":"Blue Cross MN posts its report by plan benefit package, not by contract, so each package is its own row and none is pooled in the market summary (a contract would otherwise count once per package). Counts and percentages; times in days to two decimals. Expedited requests whose review was extended: none.","notPooled":["stdApprovedPct","stdDeniedPct","appealApprovedPct","expApprovedPct","expDeniedPct"]},{"id":"bcbsmn-h5959-809","year":2025,"payer":"Blue Cross and Blue Shield of Minnesota","program":"ma","report":"H5959","part":"H5959-809 Group Medicare Advantage Elite (MAPD) BCBSMN Retirees","url":"https://bluecrossmn.widen.net/content/ur5toniz6n/original/2025-interoperability-report.pdf","readOn":"2026-10-07","stdRequests":1596,"stdApproved":1530,"stdDenied":66,"stdApprovedPct":95.86,"stdDeniedPct":4.14,"appeals":5,"appealApproved":3,"appealApprovedPct":60,"extendedRequests":1596,"extendedApproved":0,"extendedApprovedPct":0,"expRequests":52,"expApproved":51,"expDenied":1,"expApprovedPct":98.08,"expDeniedPct":1.92,"stdAvgHours":39.12,"stdMedianHours":1.2,"expAvgHours":3.6,"expMedianHours":0,"timesAsPosted":"standard 1.63 day(s) mean, 0.05 day(s) median; expedited 0.15 day(s) mean, 0.00 day(s) median","note":"Blue Cross MN posts its report by plan benefit package, not by contract, so each package is its own row and none is pooled in the market summary (a contract would otherwise count once per package). Counts and percentages; times in days to two decimals. Expedited requests whose review was extended: 0 approved of 52.","notPooled":["stdApprovedPct","stdDeniedPct","appealApprovedPct","expApprovedPct","expDeniedPct"]},{"id":"bcbsmn-h2461-005","year":2025,"payer":"Blue Cross and Blue Shield of Minnesota","program":"ma","report":"H2461","part":"H2461-005 Platinum Blue Core","url":"https://bluecrossmn.widen.net/content/ur5toniz6n/original/2025-interoperability-report.pdf","readOn":"2026-10-07","stdRequests":33,"stdApproved":32,"stdDenied":1,"stdApprovedPct":96.97,"stdDeniedPct":3.03,"appeals":0,"appealApproved":0,"appealApprovedPct":null,"extendedRequests":33,"extendedApproved":0,"extendedApprovedPct":0,"expRequests":1,"expApproved":1,"expDenied":0,"expApprovedPct":100,"expDeniedPct":0,"stdAvgHours":68.64,"stdMedianHours":29.52,"expAvgHours":9.12,"expMedianHours":9.12,"timesAsPosted":"standard 2.86 day(s) mean, 1.23 day(s) median; expedited 0.38 day(s) mean, 0.38 day(s) median","note":"Blue Cross MN posts its report by plan benefit package, not by contract, so each package is its own row and none is pooled in the market summary (a contract would otherwise count once per package). Counts and percentages; times in days to two decimals. Expedited requests whose review was extended: 0 approved of 1.","notPooled":["stdApprovedPct","stdDeniedPct","appealApprovedPct","expApprovedPct","expDeniedPct"]},{"id":"bcbsmn-h2461-006","year":2025,"payer":"Blue Cross and Blue Shield of Minnesota","program":"ma","report":"H2461","part":"H2461-006 Platinum Blue Choice","url":"https://bluecrossmn.widen.net/content/ur5toniz6n/original/2025-interoperability-report.pdf","readOn":"2026-10-07","stdRequests":183,"stdApproved":175,"stdDenied":8,"stdApprovedPct":95.63,"stdDeniedPct":4.37,"appeals":0,"appealApproved":0,"appealApprovedPct":null,"extendedRequests":183,"extendedApproved":0,"extendedApprovedPct":0,"expRequests":6,"expApproved":6,"expDenied":0,"expApprovedPct":100,"expDeniedPct":0,"stdAvgHours":67.92,"stdMedianHours":28.56,"expAvgHours":11.52,"expMedianHours":9.84,"timesAsPosted":"standard 2.83 day(s) mean, 1.19 day(s) median; expedited 0.48 day(s) mean, 0.41 day(s) median","note":"Blue Cross MN posts its report by plan benefit package, not by contract, so each package is its own row and none is pooled in the market summary (a contract would otherwise count once per package). Counts and percentages; times in days to two decimals. Expedited requests whose review was extended: 0 approved of 6.","notPooled":["stdApprovedPct","stdDeniedPct","appealApprovedPct","expApprovedPct","expDeniedPct"]},{"id":"bcbsmn-h2461-007","year":2025,"payer":"Blue Cross and Blue Shield of Minnesota","program":"ma","report":"H2461","part":"H2461-007 Platinum Blue Complete","url":"https://bluecrossmn.widen.net/content/ur5toniz6n/original/2025-interoperability-report.pdf","readOn":"2026-10-07","stdRequests":338,"stdApproved":326,"stdDenied":12,"stdApprovedPct":96.45,"stdDeniedPct":3.55,"appeals":0,"appealApproved":0,"appealApprovedPct":null,"extendedRequests":338,"extendedApproved":0,"extendedApprovedPct":0,"expRequests":10,"expApproved":10,"expDenied":0,"expApprovedPct":100,"expDeniedPct":0,"stdAvgHours":64.08,"stdMedianHours":26.16,"expAvgHours":23.52,"expMedianHours":18.24,"timesAsPosted":"standard 2.67 day(s) mean, 1.09 day(s) median; expedited 0.98 day(s) mean, 0.76 day(s) median","note":"Blue Cross MN posts its report by plan benefit package, not by contract, so each package is its own row and none is pooled in the market summary (a contract would otherwise count once per package). Counts and percentages; times in days to two decimals. Expedited requests whose review was extended: 0 approved of 10.","notPooled":["stdApprovedPct","stdDeniedPct","appealApprovedPct","expApprovedPct","expDeniedPct"]},{"id":"bcbsmn-h2461-008","year":2025,"payer":"Blue Cross and Blue Shield of Minnesota","program":"ma","report":"H2461","part":"H2461-008 Platinum Blue Core with Rx","url":"https://bluecrossmn.widen.net/content/ur5toniz6n/original/2025-interoperability-report.pdf","readOn":"2026-10-07","stdRequests":15,"stdApproved":15,"stdDenied":0,"stdApprovedPct":100,"stdDeniedPct":0,"appeals":0,"appealApproved":0,"appealApprovedPct":null,"extendedRequests":15,"extendedApproved":0,"extendedApprovedPct":0,"expRequests":1,"expApproved":1,"expDenied":0,"expApprovedPct":100,"expDeniedPct":0,"stdAvgHours":47.76,"stdMedianHours":15.84,"expAvgHours":3.6,"expMedianHours":3.6,"timesAsPosted":"standard 1.99 day(s) mean, 0.66 day(s) median; expedited 0.15 day(s) mean, 0.15 day(s) median","note":"Blue Cross MN posts its report by plan benefit package, not by contract, so each package is its own row and none is pooled in the market summary (a contract would otherwise count once per package). Counts and percentages; times in days to two decimals. Expedited requests whose review was extended: 0 approved of 1.","notPooled":["stdApprovedPct","stdDeniedPct","appealApprovedPct","expApprovedPct","expDeniedPct"]},{"id":"bcbsmn-h2461-009","year":2025,"payer":"Blue Cross and Blue Shield of Minnesota","program":"ma","report":"H2461","part":"H2461-009 Platinum Blue Choice with Rx","url":"https://bluecrossmn.widen.net/content/ur5toniz6n/original/2025-interoperability-report.pdf","readOn":"2026-10-07","stdRequests":143,"stdApproved":140,"stdDenied":3,"stdApprovedPct":97.9,"stdDeniedPct":2.1,"appeals":0,"appealApproved":0,"appealApprovedPct":null,"extendedRequests":143,"extendedApproved":0,"extendedApprovedPct":0,"expRequests":6,"expApproved":6,"expDenied":0,"expApprovedPct":100,"expDeniedPct":0,"stdAvgHours":65.04,"stdMedianHours":28.32,"expAvgHours":11.28,"expMedianHours":5.52,"timesAsPosted":"standard 2.71 day(s) mean, 1.18 day(s) median; expedited 0.47 day(s) mean, 0.23 day(s) median","note":"Blue Cross MN posts its report by plan benefit package, not by contract, so each package is its own row and none is pooled in the market summary (a contract would otherwise count once per package). Counts and percentages; times in days to two decimals. Expedited requests whose review was extended: 0 approved of 6.","notPooled":["stdApprovedPct","stdDeniedPct","appealApprovedPct","expApprovedPct","expDeniedPct"]},{"id":"bcbsmn-h2461-010","year":2025,"payer":"Blue Cross and Blue Shield of Minnesota","program":"ma","report":"H2461","part":"H2461-010 Platinum Blue Complete with Rx","url":"https://bluecrossmn.widen.net/content/ur5toniz6n/original/2025-interoperability-report.pdf","readOn":"2026-10-07","stdRequests":131,"stdApproved":130,"stdDenied":1,"stdApprovedPct":99.24,"stdDeniedPct":0.76,"appeals":1,"appealApproved":1,"appealApprovedPct":100,"extendedRequests":131,"extendedApproved":0,"extendedApprovedPct":0,"expRequests":2,"expApproved":2,"expDenied":0,"expApprovedPct":100,"expDeniedPct":0,"stdAvgHours":65.28,"stdMedianHours":27.12,"expAvgHours":4.08,"expMedianHours":4.08,"timesAsPosted":"standard 2.72 day(s) mean, 1.13 day(s) median; expedited 0.17 day(s) mean, 0.17 day(s) median","note":"Blue Cross MN posts its report by plan benefit package, not by contract, so each package is its own row and none is pooled in the market summary (a contract would otherwise count once per package). Counts and percentages; times in days to two decimals. Expedited requests whose review was extended: 0 approved of 2.","notPooled":["stdApprovedPct","stdDeniedPct","appealApprovedPct","expApprovedPct","expDeniedPct"]},{"id":"bcbsmn-h2425-001","year":2025,"payer":"Blue Cross and Blue Shield of Minnesota","program":"ma","report":"H2425","part":"H2425-001 SecureBlue","url":"https://bluecrossmn.widen.net/content/ur5toniz6n/original/2025-interoperability-report.pdf","readOn":"2026-10-07","stdRequests":47881,"stdApproved":44926,"stdDenied":2955,"stdApprovedPct":93.83,"stdDeniedPct":6.17,"appeals":933,"appealApproved":0,"appealApprovedPct":0,"extendedRequests":47881,"extendedApproved":0,"extendedApprovedPct":0,"expRequests":5270,"expApproved":5002,"expDenied":268,"expApprovedPct":94.91,"expDeniedPct":5.09,"stdAvgHours":82.32,"stdMedianHours":46.08,"expAvgHours":17.04,"expMedianHours":12.96,"timesAsPosted":"standard 3.43 day(s) mean, 1.92 day(s) median; expedited 0.71 day(s) mean, 0.54 day(s) median","note":"Blue Cross MN posts its report by plan benefit package, not by contract, so each package is its own row and none is pooled in the market summary (a contract would otherwise count once per package). Counts and percentages; times in days to two decimals. Expedited requests whose review was extended: 0 approved of 5,270. The report posts 0 of 933 appeals approved.","notPooled":["stdApprovedPct","stdDeniedPct","appealApprovedPct","expApprovedPct","expDeniedPct"]},{"id":"point32-ma-tmp","year":2025,"payer":"Point32Health","program":"ma","report":"Tufts Medicare Preferred","part":null,"url":"https://www.tuftsmedicarepreferred.org/pa-cms-tmp-report","readOn":"2026-10-07","stdRequests":4463,"stdApproved":3287,"stdDenied":1176,"stdApprovedPct":73.7,"stdDeniedPct":26.3,"appeals":null,"appealApproved":255,"appealApprovedPct":5.7,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":1511,"expApproved":795,"expDenied":214,"expApprovedPct":75.7,"expDeniedPct":24.3,"stdAvgHours":129.6,"stdMedianHours":98.4,"expAvgHours":40.5,"expMedianHours":6,"timesAsPosted":"standard 5.4 days mean, 4.1 days median; expedited 40.5 hours mean, 6.0 hours median","note":"Counts and percentages to one decimal. The approved-after-appeal rate is out of all standard requests (the number of appeals is not posted), so it is left out of the market summary. No review was extended (\"0 (no extensions)\"). Each of the posted expApprovedPct (75.7%) and expDeniedPct (24.3%) does not match the posted counts (795 and 214 of 1,511 are 52.61% and 14.16%, and add to 1,009); both are carried as posted, and these rates are left out of the market summary. One report for Tufts Medicare Preferred; no contract number is printed.","notPooled":["appealApprovedPct","expApprovedPct","expDeniedPct"],"rateMismatch":["expApprovedPct","expDeniedPct"]},{"id":"point32-ma-sco","year":2025,"payer":"Point32Health","program":"ma","report":"Senior Care Options (SCO), Massachusetts","part":null,"url":"https://www.tuftsmedicarepreferred.org/pa-cms-sco-report","readOn":"2026-10-07","stdRequests":2676,"stdApproved":2433,"stdDenied":243,"stdApprovedPct":90.9,"stdDeniedPct":9.1,"appeals":null,"appealApproved":45,"appealApprovedPct":1.7,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":782,"expApproved":704,"expDenied":78,"expApprovedPct":90,"expDeniedPct":10,"stdAvgHours":108,"stdMedianHours":88.8,"expAvgHours":12.4,"expMedianHours":1.5,"timesAsPosted":"standard 4.5 days mean, 3.7 days median; expedited 12.4 hours mean, 1.5 hours median","note":"Counts and percentages to one decimal. The approved-after-appeal rate is out of all standard requests (the number of appeals is not posted), so it is left out of the market summary. No review was extended (\"0 (no extensions)\"). Senior Care Options is a Massachusetts fully integrated dual-eligible special needs plan.","notPooled":["appealApprovedPct"]},{"id":"point32-mmp-one-care","year":2025,"payer":"Point32Health","program":"mmp","report":"One Care, Massachusetts","part":null,"url":"https://www.tuftsmedicarepreferred.org/pa-cms-one-care-report","readOn":"2026-10-07","stdRequests":9942,"stdApproved":9497,"stdDenied":445,"stdApprovedPct":95.5,"stdDeniedPct":4.5,"appeals":null,"appealApproved":31,"appealApprovedPct":0.3,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":686,"expApproved":612,"expDenied":74,"expApprovedPct":89.2,"expDeniedPct":10.8,"stdAvgHours":96,"stdMedianHours":64.8,"expAvgHours":7.6,"expMedianHours":1.3,"timesAsPosted":"standard 4.0 days mean, 2.7 days median; expedited 7.6 hours mean, 1.3 hours median","note":"Counts and percentages to one decimal. The approved-after-appeal rate is out of all standard requests (the number of appeals is not posted), so it is left out of the market summary. No review was extended (\"0 (no extensions)\"). One Care was a Medicare-Medicaid plan in 2025.","notPooled":["appealApprovedPct"]},{"id":"point32-qhp-nh","year":2025,"payer":"Point32Health","program":"qhp","report":"New Hampshire Exchange Local Choice","part":null,"url":"https://www.tuftsmedicarepreferred.org/pa-cms-nh-exchange-report","readOn":"2026-10-07","stdRequests":182,"stdApproved":150,"stdDenied":29,"stdApprovedPct":82.4,"stdDeniedPct":15.9,"appeals":null,"appealApproved":0,"appealApprovedPct":0,"extendedRequests":null,"extendedApproved":null,"extendedApprovedPct":null,"expRequests":66,"expApproved":60,"expDenied":6,"expApprovedPct":90.9,"expDeniedPct":9.1,"stdAvgHours":17.4,"stdMedianHours":5.9,"expAvgHours":12.9,"expMedianHours":3.2,"timesAsPosted":"standard 17.4 hours mean, 5.9 hours median; expedited 12.9 hours mean, 3.2 hours median","note":"Counts and percentages to one decimal. The approved-after-appeal rate is out of all standard requests (the number of appeals is not posted), so it is left out of the market summary. No review was extended (\"0 (no extensions)\"). Approved and denied add to 179, not the posted 182. Linked from harvardpilgrim.org; served from the Tufts Medicare Preferred site.","notPooled":["appealApprovedPct"]},{"id":"upmc-ma-h3907","year":2025,"payer":"UPMC Health Plan","program":"ma","report":"H3907","part":null,"url":"https://upmc.widen.net/view/pdf/zovvcggcxw/CMS_Final_Rule-Prior_Auth_Metrics-Medicare_web.xlsx?u=6vmvhg","readOn":"2026-10-07","stdRequests":93522,"stdApproved":90537,"stdDenied":2985,"stdApprovedPct":96.8,"stdDeniedPct":3.2,"appeals":530,"appealApproved":329,"appealApprovedPct":62.1,"extendedRequests":0,"extendedApproved":0,"extendedApprovedPct":null,"expRequests":6932,"expApproved":6598,"expDenied":334,"expApprovedPct":95.2,"expDeniedPct":4.8,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":"standard 1 day(s) mean, 0 day(s) median; expedited 0 day(s) mean, 0 day(s) median (whole days)","note":"Counts and percentages to one decimal; decision times in whole days, kept as posted. No review was extended (0 of 0). Read from the spreadsheet as the payer's file viewer renders it."},{"id":"upmc-ma-h5533","year":2025,"payer":"UPMC Health Plan","program":"ma","report":"H5533","part":null,"url":"https://upmc.widen.net/view/pdf/zovvcggcxw/CMS_Final_Rule-Prior_Auth_Metrics-Medicare_web.xlsx?u=6vmvhg","readOn":"2026-10-07","stdRequests":46287,"stdApproved":44752,"stdDenied":1535,"stdApprovedPct":96.7,"stdDeniedPct":3.3,"appeals":276,"appealApproved":188,"appealApprovedPct":68.1,"extendedRequests":0,"extendedApproved":0,"extendedApprovedPct":null,"expRequests":3793,"expApproved":3613,"expDenied":180,"expApprovedPct":95.3,"expDeniedPct":4.7,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":"standard 1 day(s) mean, 0 day(s) median; expedited 0 day(s) mean, 0 day(s) median (whole days)","note":"Counts and percentages to one decimal; decision times in whole days, kept as posted. No review was extended (0 of 0). Read from the spreadsheet as the payer's file viewer renders it."},{"id":"upmc-ma-h4279","year":2025,"payer":"UPMC Health Plan","program":"ma","report":"H4279","part":null,"url":"https://upmc.widen.net/view/pdf/zovvcggcxw/CMS_Final_Rule-Prior_Auth_Metrics-Medicare_web.xlsx?u=6vmvhg","readOn":"2026-10-07","stdRequests":37376,"stdApproved":35610,"stdDenied":1766,"stdApprovedPct":95.3,"stdDeniedPct":4.7,"appeals":275,"appealApproved":147,"appealApprovedPct":53.5,"extendedRequests":0,"extendedApproved":0,"extendedApprovedPct":null,"expRequests":2707,"expApproved":2544,"expDenied":163,"expApprovedPct":94,"expDeniedPct":6,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":"standard 1 day(s) mean, 0 day(s) median; expedited 0 day(s) mean, 0 day(s) median (whole days)","note":"Counts and percentages to one decimal; decision times in whole days, kept as posted. No review was extended (0 of 0). Read from the spreadsheet as the payer's file viewer renders it."},{"id":"upmc-ma-h7123","year":2025,"payer":"UPMC Health Plan","program":"ma","report":"H7123","part":null,"url":"https://upmc.widen.net/view/pdf/zovvcggcxw/CMS_Final_Rule-Prior_Auth_Metrics-Medicare_web.xlsx?u=6vmvhg","readOn":"2026-10-07","stdRequests":945,"stdApproved":871,"stdDenied":74,"stdApprovedPct":92.2,"stdDeniedPct":7.8,"appeals":8,"appealApproved":7,"appealApprovedPct":87.5,"extendedRequests":0,"extendedApproved":0,"extendedApprovedPct":null,"expRequests":269,"expApproved":237,"expDenied":32,"expApprovedPct":88.1,"expDeniedPct":11.9,"stdAvgHours":null,"stdMedianHours":null,"expAvgHours":null,"expMedianHours":null,"timesAsPosted":"standard 2 day(s) mean, 0 day(s) median; expedited 1 day(s) mean, 0 day(s) median (whole days)","note":"Counts and percentages to one decimal; decision times in whole days, kept as posted. No review was extended (0 of 0). Read from the spreadsheet as the payer's file viewer renders it."}]