Filing · f0240
Fallon Health – Atrius Health Care Collaborative (365 Care)
Fallon Health · Medicaid Managed Care · MA · CY2025
In 2025 this plan received 18,169 standard prior authorization requests and denied 6.8% of them. The median for Medicaid Managed Care plans of comparable size is 13.2%.
Standard denial rate
6.8%
18,169 standard requests, 1,240 denied.
75.4% of appealed denials were overturned.
Requests and outcomes
| Total | Approved | Denied | Denial rate | |
|---|---|---|---|---|
| Standard | 18,169 | 16,929 | 1,240 | 6.8% |
| Expedited | 2,705 | 2,619 | 86 | 3.2% |
This payer also printed its own standard denial rate: 7.0%. The rate above is computed from the published counts, so the two can be compared.
Appeals of standard denials
| Appeals filed | 171 |
| Denials overturned | 129 |
| Overturn rate | 75.4% |
Turnaround
| Mean | Median | |
|---|---|---|
| Standard | 3.0 d | 0.0 d |
| Expedited | 6.0 h | 0.0 h |