Filing · f0536

Yamhill Community Care

Yamhill Community Care · Medicaid Managed Care · OR · CY2025

In 2025 this plan received 13,867 standard prior authorization requests and denied 11.8% of them. The median for Medicaid Managed Care plans of comparable size is 13.2%. One check flagged this filing.

Standard denial rate

11.8%

13,867 standard requests, 1,633 denied.

Requests and outcomes

	Total	Approved	Denied	Denial rate
Standard	13,867	12,234	1,633	11.8%
Expedited	1,215	1,147	68	5.6%
Extended review, approved	38

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	6.1 d	5.0 d
Expedited	29.0 h	24.0 h

What the checks found

infoappeals_not_reported

no appeal outcome data published

Source

https://yamhillcco.org/wp-content/uploads/2026/03/2721587_CY2025AuthMetricsCMS_031226.pdf

Standard sums tie exactly: 12,234 approved + 1,633 denied = 13,867 = printed total. Expedited also ties exactly: 1,147 + 68 = 1,215. Document reports expedited turnaround explicitly in DAYS (mean 1.21 days, median 1 day); converted to hours (29.04 and 24) per the unit-conversion rule since the source unit was labeled. Document also prints 'approved after appeal: 5' and 'denied after appeal: 118' (standard), and 'approved after appeal: 1' / 'denied after appeal: 12' (expedited) as raw counts rather than a total-appeals-filed figure or an overturn percentage — std_appeals_total/std_appeals_overturned were left null rather than summing the two printed counts into a total that was not itself printed. Document also prints 'extended review denied: 18' (standard) and 'extended review approved: 5' / 'extended review denied: 7' (expedited), for which there is no matching schema field beyond the one std ext_review_approved slot used above.

Filing ID: f0536
Published: counts
Collector: w3_west