Filing · f0138
Ambetter of North Carolina (77264)
Centene · Marketplace QHP · NC · 77264 · CY2025
In 2025 this plan received 50,371 standard prior authorization requests and denied 20.7% of them. The median for Marketplace QHP plans of comparable size is 18.3%.
Standard denial rate
20.7%
50,371 standard requests, 10,418 denied.
51.8% of appealed denials were overturned.
Requests and outcomes
| Total | Approved | Denied | Denial rate | |
|---|---|---|---|---|
| Standard | 50,371 | 39,953 | 10,418 | 20.7% |
| Expedited | 1,602 | 1,215 | 387 | 24.2% |
| Extended review, approved | 886 | |||
Appeals of standard denials
| Appeals filed | 1,679 |
| Denials overturned | 870 |
| Overturn rate | 51.8% |
Turnaround
| Mean | Median | |
|---|---|---|
| Standard | 2.0 d | 1.0 d |
| Expedited | 24.0 h | 24.0 h |