Filing · f0337

IEHP DualChoice (HMO D-SNP)

Inland Empire Health Plan · Medicare Advantage · CA · H8894 · CY2025

In 2025 this plan received 92,672 standard prior authorization requests and denied 2.0% of them. The median for Medicare Advantage plans of comparable size is 10.5%.

Standard denial rate

2.0%

92,672 standard requests, 1,861 denied.

Requests and outcomes

	Total	Approved	Denied	Denial rate
Standard	92,672	90,811	1,861	2.0%
Expedited	24,380	23,825	555	2.3%
Extended review, approved	0

Appeals of standard denials

Appeals filed	—
Denials overturned	5
Overturn rate	—

This filing publishes no appeal outcome. CMS-0057-F does not require one.

Turnaround

	Mean	Median
Standard	5.2 d	6.1 d
Expedited	10.3 h	2.2 h

Source

https://www.iehp.org/content/dam/iehp-org/en/documents/medi-cal/prior-authorization/2025/report/CY26_PriorAuthReport2025_EN-update.pdf

Transcribed from IEHP's three-column infographic report; the same document is published under each product's path. Columns are Medi-Cal, DualChoice (D-SNP) and Covered California. The three unlabeled figures per column are denied, approved after appeal, and approved, which reconcile against the printed total. IEHP counts partial approvals as denials and continuations as urgent, per its own notes. Appeal totals are not printed — only the percentage approved after appeal — so appeal counts stay null. Decision times are printed in days for both classes; urgent converted to hours.

Filing ID: f0337
Published: counts
Collector: w5_states

Other Inland Empire Health Plan filings

IEHP Medi-Cal	1.1%
IEHP Covered California	2.1%