Filing · f0386

MetroPlus Partnership in Care (HIV SNP)

MetroPlus Health Plan · Medicaid Managed Care · NY · CY2025

In 2025 this plan received 2,151 standard prior authorization requests and denied 15.7% of them. The median for Medicaid Managed Care plans of comparable size is 12.3%.

Standard denial rate

15.7%

2,151 standard requests, 337 denied. 33.0% of appealed denials were overturned.

Requests and outcomes

	Total	Approved	Denied	Denial rate
Standard	2,151	1,814	337	15.7%
Expedited	14	14	0	0.0%
Extended review, approved	20

This payer also printed its own standard denial rate: 15.7%. The rate above is computed from the published counts, so the two can be compared.

Appeals of standard denials

Appeals filed	97
Denials overturned	32
Overturn rate	33.0%

Turnaround

	Mean	Median
Standard	2.3 d	0.7 d
Expedited	13.7 h	4.8 h

Source

https://metroplus.org/wp-content/uploads/2026/07/PICSNP_HA-851_20260622.xlsx

Parsed from MetroPlus's published workbook (the CMS template as an xlsx). Percentages are stored as fractions in the sheet and converted. Both turnaround rows are in days; expedited converted to hours. The workbook the earlier crawl recorded as an unreadable binary gap -- now read.

Filing ID: f0386
Published: counts
Collector: w5_metroplus

Other MetroPlus Health Plan filings

MetroPlus Medicaid Managed Care	15.4%
MetroPlus Medicare (H0423)	12.0%
MetroPlus HARP	19.0%
MetroPlus Managed Long Term Care	19.8%
MetroPlus Child Health Plus	13.8%
MetroPlus Medicaid Advantage Plus	6.4%