Filing · ca-ccs-2025

California Children's Services (CCS)

California DHCS · Medicaid FFS · CA · CY2025

In 2025 this plan received 755,850 standard prior authorization requests and denied 26.5% of them. The median for Medicaid FFS plans of comparable size is 7.4%.

Standard denial rate

26.5%

755,850 standard requests, 200,549 denied. 6.7% of appealed denials were overturned.

Requests and outcomes

	Total	Approved	Denied	Denial rate
Standard	755,850	555,301	200,549	26.5%
Expedited	—	—	—	—
Extended review, approved	304,799

Appeals of standard denials

Appeals filed	15
Denials overturned	1
Overturn rate	6.7%

Turnaround

	Mean	Median
Standard	9.0 d	2.0 d
Expedited	—	—

Source

https://www.dhcs.ca.gov/vi/provgovpart/Documents/Interoperability-Prior-Auth-Metrics-Reports/CCS-2025-Prior-Auth-Metrics.pdf

Document states all prior authorizations (standard and expedited) are reported together, so the denominator is combined. Headline figures are 555,301 approved / 200,549 denied of 755,850 (73%/27%); the 442,990 / 139,846 pair printed alongside is the within-7-days subset, not the total. Two independent extraction passes disagreed on which pair was the headline; resolved to the document total.

Filing ID: ca-ccs-2025
Published: counts
Collector: filings_2025

Other California DHCS filings

Medi-Cal Dental Fee-for-Service	29.5%
Medi-Cal Fee-for-Service (medical and behavioral health)	28.4%