Filing · f0388
SCFHP DualConnect (HMO D-SNP)
Santa Clara Family Health Plan · Medicare Advantage · CA · CY2025
In 2025 this plan received 13,446 standard prior authorization requests and denied 9.1% of them. The median for Medicare Advantage plans of comparable size is 10.9%.
Standard denial rate
9.1%
13,446 standard requests, 1,219 denied.
42.9% of appealed denials were overturned.
Requests and outcomes
| Total | Approved | Denied | Denial rate | |
|---|---|---|---|---|
| Standard | 13,446 | 12,197 | 1,219 | 9.1% |
| Expedited | 7,258 | 6,798 | 460 | 6.3% |
| Extended review, approved | 0 | |||
Appeals of standard denials
| Appeals filed | 254 |
| Denials overturned | 109 |
| Overturn rate | 42.9% |
Turnaround
| Mean | Median | |
|---|---|---|
| Standard | 7.4 d | 6.4 d |
| Expedited | 20.2 h | 19.0 h |