Filing · f0264
MLTC
Healthfirst · Medicaid Managed Care · NY ·
In 2025 this plan received 30,359 standard prior authorization requests and denied 12.8% of them. The median for Medicaid Managed Care plans of comparable size is 12.3%.
Standard denial rate
12.8%
30,359 standard requests, 3,888 denied.
10.4% of appealed denials were overturned.
Requests and outcomes
| Total | Approved | Denied | Denial rate | |
|---|---|---|---|---|
| Standard | 30,359 | 26,471 | 3,888 | 12.8% |
| Expedited | 66 | 50 | 16 | 24.2% |
| Extended review, approved | 6 | |||
This payer also printed its own standard denial rate: 13.0%. The rate above is computed from the published counts, so the two can be compared.
Appeals of standard denials
| Appeals filed | 309 |
| Denials overturned | 32 |
| Overturn rate | 10.4% |
Turnaround
| Mean | Median | |
|---|---|---|
| Standard | 2.1 d | 0.0 d |
| Expedited | — | — |