Filing · f0013
AmeriHealth Caritas North Carolina
AmeriHealth Caritas · Medicaid Managed Care · NC · CY2025
In 2025 this plan received 77,905 standard prior authorization requests and denied 15.0% of them. The median for Medicaid Managed Care plans of comparable size is 13.2%. 2 checks flagged this filing.
Standard denial rate
15.0%
77,905 standard requests, 11,698 denied.
Requests and outcomes
| Total | Approved | Denied | Denial rate | |
|---|---|---|---|---|
| Standard | 77,905 | 65,448 | 11,698 | 15.0% |
| Expedited | 1,410 | 1,192 | 174 | 12.3% |
Appeals of standard denials
| Appeals filed | — |
| Denials overturned | 392 |
| Overturn rate | — |
This filing publishes no appeal outcome. CMS-0057-F does not require one.
Turnaround
| Mean | Median | |
|---|---|---|
| Standard | 3.5 d | 1.0 d |
| Expedited | 14.0 h | 19.0 h |
What the checks found
errorexp_counts_reconcile
1,192 approved + 174 denied = 1,366, but total is 1,410 (44 unaccounted, 3.1%)
errorstd_counts_reconcile
65,448 approved + 11,698 denied = 77,146, but total is 77,905 (759 unaccounted, 1.0%)