Filing · f0338

IEHP Medi-Cal

Inland Empire Health Plan · Medicaid Managed Care · CA · CY2025

In 2025 this plan received 3,017,509 standard prior authorization requests and denied 1.1% of them. The median for Medicaid Managed Care plans of comparable size is 12.3%.

Standard denial rate

1.1%

3,017,509 standard requests, 32,642 denied.

Requests and outcomes

	Total	Approved	Denied	Denial rate
Standard	3,017,509	2,984,867	32,642	1.1%
Expedited	543,529	537,136	6,393	1.2%
Extended review, approved	0

Appeals of standard denials

Appeals filed	—
Denials overturned	423
Overturn rate	—

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

Turnaround

	Mean	Median
Standard	2.1 d	0.6 d
Expedited	5.0 h	0.5 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: f0338
Published: counts
Collector: w5_states

Other Inland Empire Health Plan filings

IEHP Covered California	2.1%
IEHP DualChoice (HMO D-SNP)	2.0%