Filing · f0389
SCFHP Medi-Cal
Santa Clara Family Health Plan · Medicaid Managed Care · CA · CY2025
In 2025 this plan received 181,930 standard prior authorization requests and denied 4.0% of them. The median for Medicaid Managed Care plans of comparable size is 13.2%.
Standard denial rate
4.0%
181,930 standard requests, 7,294 denied.
26.6% of appealed denials were overturned.
Requests and outcomes
| Total | Approved | Denied | Denial rate | |
|---|---|---|---|---|
| Standard | 181,930 | 174,636 | 7,294 | 4.0% |
| Expedited | 26,119 | 24,402 | 1,717 | 6.6% |
| Extended review, approved | 0 | |||
Appeals of standard denials
| Appeals filed | 312 |
| Denials overturned | 83 |
| Overturn rate | 26.6% |
Turnaround
| Mean | Median | |
|---|---|---|
| Standard | 5.0 d | 5.3 d |
| Expedited | 20.4 h | 19.0 h |