Filing · f0533

Wisconsin Medicaid (ForwardHealth) -- specific program/agency not named in document

Wisconsin Department of Health Services · Medicaid FFS · WI · Reporting Year 2025

In 2025 this plan received 165,012 standard prior authorization requests and denied 4.0% of them. The median for Medicaid FFS plans of comparable size is 7.4%. 3 checks flagged this filing.

Standard denial rate

4.0%

165,012 standard requests, 6,556 denied.

Requests and outcomes

	Total	Approved	Denied	Denial rate
Standard	165,012	148,796	6,556	4.0%
Expedited	10	9	0	0.0%

This payer also printed its own standard denial rate: 4.0%. The rate above is computed from the published counts, so the two can be compared.

Appeals of standard denials

Appeals filed	—
Denials overturned	—
Overturn rate	—

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

Turnaround

	Mean	Median
Standard	3.1 d	1.0 d
Expedited	151.2 h	67.2 h

What the checks found

errorstd_counts_reconcile

148,796 approved + 6,556 denied = 155,352, but total is 165,012 (9,660 unaccounted, 5.9%)

warnexpedited_slower_than_standard

expedited mean 151.2h exceeds standard mean 3.10d (74h)

infoappeals_not_reported

no appeal outcome data published

Source

https://www.dhs.wisconsin.gov/medicaid/pa-report-2025.pdf

Document title is only 'Prior Authorization Metrics Reporting Year 2025' -- it names no specific plan, MCO, or program (no BadgerCare Plus / ForwardHealth / managed-care label appears). Hosted on the WI DHS Medicaid pages alongside ForwardHealth FFS pharmacy/PA administrative-code material, so classified here as Medicaid FFS, but this could instead be a statewide combined FFS+MCO carve-in PA determination log -- flag for verification by someone who can see the full PDF. Document also reports a separate 'Partially Denied' bucket not in this schema: standard 9,660 (5.9%%), expedited 1 -- omitted from typed fields, noted here. Standard TAT is explicitly labeled in days (3.1 mean / 1.0 median). Expedited TAT is ALSO explicitly labeled in days (6.3 mean / 2.8 median) rather than hours; converted per brief instructions (days->hours: 6.3*24=151.2, 2.8*24=67.2) and flagged as a conversion. Note the apparent anomaly that expedited turnaround (151.2h / 67.2h) is far slower than standard (3.1 days = 74.4h / 1.0 day = 24h) -- printed as-is; worth scrutiny downstream. No appeals data reported.

Filing ID: f0533
Published: counts
Collector: w3_midwest