Filing · f0108
CalOptima Health Medi-Cal
CalOptima Health · Medicaid Managed Care · CA · CY2025
In 2025 this plan received 965,191 standard prior authorization requests and denied 1.7% of them. The median for Medicaid Managed Care plans of comparable size is 13.2%.
Standard denial rate
1.7%
965,191 standard requests, 16,568 denied.
28.3% of appealed denials were overturned.
Requests and outcomes
| Total | Approved | Denied | Denial rate | |
|---|---|---|---|---|
| Standard | 965,191 | 948,623 | 16,568 | 1.7% |
| Expedited | 140,631 | 136,258 | 4,373 | 3.1% |
| Extended review, approved | 1,955 | |||
Appeals of standard denials
| Appeals filed | 1,080 |
| Denials overturned | 306 |
| Overturn rate | 28.3% |
Turnaround
| Mean | Median | |
|---|---|---|
| Standard | 1.4 d | 0.5 d |
| Expedited | 0.0 h | 2.9 h |