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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.

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72 of 536
filings in view
9.5M
standard requests
12.5%
volume-weighted denial rate
3
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
8
31
29
4
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 Managed Care 7.1M 38 filings
Marketplace QHP 1.6M 20 filings
Medicare Advantage 730K 11 filings
CHIP Managed Care 38K 2 filings
Medicare-Medicaid Plan 20K 1 filings

Filings

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Denial rate Volume Organization Findings
Organization
Plan
Market
St
Std reqs
Denial rate
Findings
Centene Ambetter from Superior HealthPlan (29418) Marketplace QHP TX 218K 32.9% 1 Centene Ambetter from Superior HealthPlan (87226) Marketplace QHP TX 90K 32.5% 1 Centene Oklahoma Complete Health - SoonerSelect Medicaid Managed Care OK 73K 32.4% — Centene Ambetter of Oklahoma Marketplace QHP OK 38K 30.1% — Centene Ambetter of Alabama Marketplace QHP AL 39K 28.5% — Centene Ambetter from Buckeye Health Plan Marketplace QHP OH 53K 28.4% — Centene Ambetter Health of Delaware Marketplace QHP DE 3K 27.7% — Centene Ambetter from Arizona Complete Health (91450) Marketplace QHP AZ 54K 26.0% — Centene MHS Indiana - Healthy Indiana Plan Medicaid Managed Care IN 79K 25.7% — Centene Ambetter from Sunflower Health Plan (34368) Marketplace QHP KS 64K 25.5% — Centene MHS Indiana - Hoosier Care Connect Medicaid Managed Care IN 28K 25.2% — Centene SilverSummit Healthplan Medicaid Medicaid Managed Care NV 32K 24.7% — Centene Buckeye Health Plan (Ohio Medicaid) Medicaid Managed Care OH 146K 24.7% — Centene Ambetter Health (Indiana / MHS Indiana marketplace) Marketplace QHP IN 57K 24.6% — Centene Ambetter from Louisiana Healthcare Connections Marketplace QHP LA 23K 24.3% — Centene Nebraska Total Care Medicaid Managed Care NE 53K 24.2% — Centene Arizona Complete Health - Complete Care Medicaid Managed Care AZ 164K 23.3% — Centene Ambetter from NH Healthy Families Marketplace QHP NH 16K 23.1% — Centene Oklahoma Complete Health - Children's Specialty Program Medicaid Managed Care OK 9K 23.0% — Centene Ambetter from Home State Health (99723) Marketplace QHP MO 90K 22.8% — Centene Ambetter of Tennessee Marketplace QHP TN 105K 22.8% — Centene Ambetter from Meridian Marketplace QHP MI 42K 22.7% — Centene Meridian Illinois Medicaid Medicaid Managed Care IL 316K 22.6% — Centene Louisiana Healthcare Connections Medicaid Managed Care LA 154K 22.6% — Centene Ambetter Health (Nebraska Total Care marketplace) Marketplace QHP NE 37K 22.5% — Centene Ambetter from Magnolia Health (90714) Marketplace QHP MS 92K 21.5% — Centene Ambetter from Absolute Total Care (79222) Marketplace QHP SC 99K 21.5% — Centene Coordinated Care (Apple Health) Medicaid Managed Care WA 55K 21.3% — Centene Ambetter Health Florida / Celtic (49004) Marketplace QHP FL 419K 21.0% — Centene Meridian Michigan Medicaid Medicaid Managed Care MI 122K 21.0% — Centene Home State Health (MO HealthNet) Medicaid Managed Care MO 130K 21.0% — Centene MHS Indiana - Hoosier Healthwise Medicaid Managed Care IN 35K 20.7% — Centene Ambetter of North Carolina (77264) Marketplace QHP NC 50K 20.7% — Centene Wellcare by Superior HealthPlan H7323 Medicare Advantage TX 14K 19.2% — Centene Arkansas Total Care (PASSE) Medicaid Managed Care AR 27K 19.1% — Centene Wellcare Medicare Advantage H2117 Medicare Advantage MI 18K 18.8% — Centene Sunshine Health Medicaid MMA Medicaid Managed Care FL 418K 18.3% — Centene Ambetter Health Florida (86382) Marketplace QHP FL 6K 18.3% — Centene Magnolia Health Plan (MSCAN) Medicaid Managed Care MS 105K 18.2% — Centene Absolute Total Care Medicaid Medicaid Managed Care SC 57K 17.7% — Centene Wellcare Medicare Advantage H0351 Medicare Advantage AZ 33K 17.3% — Centene Wellcare Medicare Advantage H5590 Medicare Advantage AZ 44K 17.1% — Centene Wellcare Medicare Advantage H0074 Medicare Advantage MS 3K 16.9% — Centene Peach State Health Plan Medicaid Medicaid Managed Care GA 215K 16.9% — Centene MHS Health Wisconsin (MHS line) Medicaid Managed Care WI 14K 16.8% — Centene Wellcare Medicare Advantage H5779 Medicare Advantage IL 15K 16.6% — Centene Pennsylvania Health & Wellness (Community HealthChoices) Medicaid Managed Care PA 20K 16.5% — Centene Wellcare Medicare Advantage H6550 Medicare Advantage KS 6K 15.9% — Centene Wellcare Medicare Advantage H9387 Medicare Advantage KS 2K 15.5% — Centene WellCare of North Carolina Medicaid Managed Care NC 147K 15.1% — Centene MHS Health Wisconsin (NHP line) Medicaid Managed Care WI 11K 15.0% — Centene WellCare of Kentucky Medicaid Managed Care KY 357K 14.9% — Centene Home State Health - Show Me Healthy Kids Medicaid Managed Care MO 18K 14.8% — Centene Trillium Community Health Plan - Tri-County Medicaid Managed Care OR 14K 14.7% — Centene Trillium Community Health Plan - Southwest Medicaid Managed Care OR 10K 14.3% — Centene Carolina Complete Health Medicaid Managed Care NC 71K 14.1% — Centene NH Healthy Families Medicaid Managed Care NH 40K 13.4% 1 Centene Iowa Total Care Medicaid Managed Care IA 155K 13.2% — Centene YouthCare (HealthChoice Illinois Medicaid) Medicaid Managed Care IL 10K 13.2% — Centene Delaware First Health Medicaid Medicaid Managed Care DE 15K 12.8% — Centene Delaware First Health CHIP CHIP Managed Care DE 618 12.1% — Centene Sunflower Health Plan (KanCare) Medicaid Managed Care KS 82K 12.1% — Centene Sunshine Health Children's Medical Services (Title XXI) CHIP Managed Care FL 37K 11.4% — Centene Sunshine Health Children's Medical Services (Title XIX) Medicaid Managed Care FL 297K 10.5% — Centene Community Health Plan of Imperial Valley Medi-Cal Medicaid Managed Care CA 57K 7.6% — Centene Buckeye MyCare Ohio Medicare-Medicaid Plan OH 20K 7.2% — Centene CalViva Health Medi-Cal Medicaid Managed Care CA 310K 6.3% — Centene Wellcare Medicare Advantage H5087 Medicare Advantage CA 120K 2.8% — Centene Health Net Medi-Cal Medicaid Managed Care CA 3.1M 2.5% — Centene Wellcare By Health Net H3561 Medicare Advantage CA 290K 2.0% — Centene Wellcare By Health Net H0562 Medicare Advantage CA 185K 1.9% — Centene Sunshine Health Long-Term Care Medicaid Managed Care FL 135K 1.4% —