Filing · f0335

Indiana Health Coverage Programs (fee-for-service)

Indiana Family and Social Services Administration · Medicaid FFS · IN · 01/01/2025 through 12/31/2025

In 2025 this plan received 204,568 standard prior authorization requests and denied 5.1% of them. The median for Medicaid FFS plans of comparable size is 8.3%. 2 checks flagged this filing.

Standard denial rate

5.1%

204,568 standard requests, 10,442 denied. 27.8% of appealed denials were overturned.

Requests and outcomes

	Total	Approved	Denied	Denial rate
Standard	204,568	179,701	10,442	5.1%
Expedited	2,174	1,844	66	3.0%
Extended review, approved	40,268

This payer also printed its own standard denial rate: 5.1%. The rate above is computed from the published counts, so the two can be compared.

Appeals of standard denials

Appeals filed	583
Denials overturned	162
Overturn rate	27.8%

Turnaround

	Mean	Median
Standard	2.1 d	2.0 d
Expedited	19.2 h	9.0 h

What the checks found

errorexp_counts_reconcile

1,844 approved + 66 denied = 1,910, but total is 2,174 (264 unaccounted, 12.1%)

errorstd_counts_reconcile

179,701 approved + 10,442 denied = 190,143, but total is 204,568 (14,425 unaccounted, 7.1%)