Filing · f0017
Keystone First
AmeriHealth Caritas · Medicaid Managed Care · PA · CY2025
In 2025 this plan received 314,611 standard prior authorization requests and denied 28.4% of them. The median for Medicaid Managed Care plans of comparable size is 12.3%. One check flagged this filing.
Standard denial rate
28.4%
314,611 standard requests, 89,408 denied.
Requests and outcomes
| Total | Approved | Denied | Denial rate | |
|---|---|---|---|---|
| Standard | 314,611 | 234,056 | 89,408 | 28.4% |
| Expedited | 1,933 | 1,523 | 410 | 21.2% |
Appeals of standard denials
| Appeals filed | — |
| Denials overturned | 792 |
| Overturn rate | — |
This filing publishes no appeal outcome. CMS-0057-F does not require one.
Turnaround
| Mean | Median | |
|---|---|---|
| Standard | 4.8 d | 2.0 d |
| Expedited | 66.9 h | 17.0 h |
What the checks found
errorstd_counts_reconcile
234,056 approved + 89,408 denied = 323,464, but total is 314,611 (-8,853 unaccounted, 2.8%)