Filing · f0320
Humana Healthy Horizons in South Carolina
Humana · Medicaid Managed Care · SC · 2025
In 2025 this plan received 14,667 standard prior authorization requests and denied 10.9% of them. The median for Medicaid Managed Care plans of comparable size is 12.3%.
Standard denial rate
10.9%
14,667 standard requests, 1,593 denied.
43.8% of appealed denials were overturned.
Requests and outcomes
| Total | Approved | Denied | Denial rate | |
|---|---|---|---|---|
| Standard | 14,667 | 13,074 | 1,593 | 10.9% |
| Expedited | 3,799 | 1,541 | 2,258 | 59.4% |
| Extended review, approved | 0 | |||
This payer also printed its own standard denial rate: 10.9%. The rate above is computed from the published counts, so the two can be compared.
Appeals of standard denials
| Appeals filed | 48 |
| Denials overturned | 21 |
| Overturn rate | 43.8% |
Turnaround
| Mean | Median | |
|---|---|---|
| Standard | 3.0 d | 2.0 d |
| Expedited | 10.0 h | 8.0 h |