Filing · f0172
Sunshine Health Children's Medical Services (Title XIX)
Centene · Medicaid Managed Care · FL · CY2025
In 2025 this plan received 296,583 standard prior authorization requests and denied 10.5% of them. The median for Medicaid Managed Care plans of comparable size is 13.2%.
Standard denial rate
10.5%
296,583 standard requests, 31,083 denied.
26.4% of appealed denials were overturned.
Requests and outcomes
| Total | Approved | Denied | Denial rate | |
|---|---|---|---|---|
| Standard | 296,583 | 265,500 | 31,083 | 10.5% |
| Expedited | 7,385 | 7,122 | 263 | 3.6% |
| Extended review, approved | 3,546 | |||
Appeals of standard denials
| Appeals filed | 5,684 |
| Denials overturned | 1,502 |
| Overturn rate | 26.4% |
Turnaround
| Mean | Median | |
|---|---|---|
| Standard | 2.0 d | 0.0 d |
| Expedited | 24.0 h | 0.0 h |