Filing · f0049
CDPHP Medicare HMO
CDPHP · Medicare Advantage · NY · H3388 · CY2025
In 2025 this plan received 19,167 standard prior authorization requests and denied 11.9% of them. The median for Medicare Advantage plans of comparable size is 10.9%.
Standard denial rate
11.9%
19,167 standard requests, 2,276 denied.
64.1% of appealed denials were overturned.
Requests and outcomes
| Total | Approved | Denied | Denial rate | |
|---|---|---|---|---|
| Standard | 19,167 | 16,891 | 2,276 | 11.9% |
| Expedited | 1,323 | 1,284 | 39 | 3.0% |
| Extended review, approved | 5 | |||
Appeals of standard denials
| Appeals filed | 270 |
| Denials overturned | 173 |
| Overturn rate | 64.1% |
Turnaround
| Mean | Median | |
|---|---|---|
| Standard | 3.0 d | 1.0 d |
| Expedited | 31.0 h | 24.0 h |