Filing · f0175
Sunshine Health Medicaid MMA
Centene · Medicaid Managed Care · FL · CY2025
In 2025 this plan received 418,298 standard prior authorization requests and denied 18.3% of them. The median for Medicaid Managed Care plans of comparable size is 13.2%.
Standard denial rate
18.3%
418,298 standard requests, 76,605 denied.
49.4% of appealed denials were overturned.
Requests and outcomes
| Total | Approved | Denied | Denial rate | |
|---|---|---|---|---|
| Standard | 418,298 | 341,693 | 76,605 | 18.3% |
| Expedited | 13,003 | 11,238 | 1,765 | 13.6% |
| Extended review, approved | 6,472 | |||
Appeals of standard denials
| Appeals filed | 7,401 |
| Denials overturned | 3,657 |
| Overturn rate | 49.4% |
Turnaround
| Mean | Median | |
|---|---|---|
| Standard | 2.0 d | 1.0 d |
| Expedited | 24.0 h | 0.0 h |