Reporting Year: 2025
Client: DHCS
Medicaid
State: California
Summary Prior Authorization Requests
| Type of Metrics | Count |
|---|---|
| Total number of prior authorizations requested in 2025 | 143,605 |
| Total number of standard prior authorization received in 2025 | 138,652 |
| Total number of expedited prior authorizations received in 2025 | 4,953 |
Standard Prior Authorization Requests
| Type of Decision | Count of how many times this happened | Total Requests | Percentage |
|---|---|---|---|
| Request approved | 50,157 | 138,652 | 36% |
| Request approved after time for review was extended | 0 | 0 | 0% |
| Request approved after appeal | 199 | 1,085 | 18% |
| Request denied | 88,495 | 138,652 | 64% |
| Request denied after time for review was extended | 0 | 0 | 0% |
| Request denied after appeal | 886 | 1,085 | 82% |
* Counts calculated at the authorization level; Partially Approved/Denied are included in Denial category
Expedited/Urgent Prior Authorization Requests
| Type of Decision | Count of how many times this happened | Total Requests | Percentage |
|---|---|---|---|
| Request approved | 3,703 | 4,953 | 75% |
| Request approved after time for review was extended | 0 | 0 | 0% |
| Request approved after appeal | 3 | 12 | 25% |
| Request denied | 1,250 | 4,953 | 25% |
| Request denied after time for review was extended | 0 | 0 | 0% |
| Request denied after appeal | 9 | 12 | 75% |
* Counts calculated at the authorization level; Partially Approved/Denied are included in Denial category
Time between receiving a prior authorization request and sending a decision
| Average Turn Around Time | Median Turn Around Time | |
|---|---|---|
| Non-urgent Prior Authorization Requests | 5.2 days | 5.0 days |
| Urgent Prior Authorization Requests | 0.8 days | 1.0 days |