Filing · f0230
EmblemHealth Medicaid and HARP (combined)
EmblemHealth · Medicaid Managed Care · NY · CY2025
In 2025 this plan received 115,230 standard prior authorization requests and denied 22.5% of them. The median for Medicaid Managed Care plans of comparable size is 13.2%.
Standard denial rate
22.5%
115,230 standard requests, 25,872 denied.
Requests and outcomes
| Total | Approved | Denied | Denial rate | |
|---|---|---|---|---|
| Standard | 115,230 | 89,358 | 25,872 | 22.5% |
| Expedited | 5,302 | 4,574 | 728 | 13.7% |
| Extended review, approved | 196 | |||
Appeals of standard denials
| Appeals filed | — |
| Denials overturned | 546 |
| Overturn rate | — |
This filing publishes no appeal outcome. CMS-0057-F does not require one.
Turnaround
| Mean | Median | |
|---|---|---|
| Standard | 2.1 d | — |
| Expedited | — | — |