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Prior authorization denial rates, plan by plan

Every plan that published a CY2025 filing. Search for an insurer or a plan by name, narrow by state or market, and the charts and the weighted rate below recompute as you go.

Search Market State Min volume · no minimum Reset

19 of 536

filings in view

8.6M

standard requests

20.7%

volume-weighted denial rate

with validation findings

The weighted rate is computed over filings in view that published both a request total and a denial count; the request figure beside it counts every filing in view.

Distribution of denial rates

filings per 10-point band

0–10%

10–20%

20–30%

30–40%

40–50%

50–65%

Denial rate vs. request volume

log volume, 1K → 500K · orange marks carry findings

1K10K100K500K

Request volume by market, current filter

Medicaid FFS 8.6M 19 filings

Filings

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Denial rate Volume Organization Findings

Organization

Plan

Market

Std reqs

Denial rate

Findings

California DHCS Medi-Cal Dental Fee-for-Service Medicaid FFS CA 3.1M 29.5% — California DHCS Medi-Cal Fee-for-Service (medical and behavioral health) Medicaid FFS CA 79K 28.4% 1 California DHCS California Children's Services (CCS) Medicaid FFS CA 756K 26.5% — Virginia DMAS Virginia Medicaid Fee-for-Service (Cardinal Care FFS) Medicaid FFS VA 724K 24.4% — Colorado HCPF Health First Colorado / CHP+ (13 PA programs combined) Medicaid FFS CO 1.7M 22.3% — Ohio Department of Medicaid Ohio Medicaid Fee-for-Service Medicaid FFS OH 31K 17.1% — Commonwealth of Massachusetts Calendar Year 2025 Prior Authorization Metrics (program not named in document) Medicaid FFS MA — 14.6% — Wyoming Department of Health Wyoming Medicaid Utilization Management (FFS) Medicaid FFS WY 11K 10.3% 1 Mississippi Division of Medicaid Mississippi Medicaid Fee-for-Service Medicaid FFS MS 60K 10.2% 2 Hawaii Med-QUEST Med-QUEST aggregate (QUEST Integration plans plus FFS) Medicaid FFS HI 122K 8.3% — Connecticut DSS Connecticut Medicaid (HUSKY) FFS - Medical Medicaid FFS CT 255K 6.4% — Michigan Department of Health and Human Services Michigan Medicaid Home and Community Based Services (Aging and Community Services Division, incl. Brain Injury Services and Community Transition Services) - Fee-for-Service Medicaid FFS MI 3K 5.2% 1 Wisconsin Department of Health Services Wisconsin Medicaid (ForwardHealth) -- specific program/agency not named in document Medicaid FFS WI 165K 4.0% 2 Utah DHHS Utah Medicaid Medicaid FFS UT 30K 2.8% — Alaska Department of Health Alaska Medicaid (fee-for-service) Medicaid FFS AK 430K 2.1% — Connecticut DSS Connecticut Medicaid (HUSKY) FFS - Behavioral Health Medicaid FFS CT 105K 0.8% — New Jersey DMAHS NJ FamilyCare / Medicaid Fee-for-Service Medicaid FFS NJ 890K 0.3% — Magellan Healthcare Wyoming High Fidelity Wraparound CME Medicaid FFS WY 1K 0.0% 1 Wyoming Department of Health Wyoming Medicaid Home and Community Based Services Medicaid FFS WY 32K 0.0% 1