Prior Authorization Reporting for Medicare Advantage Plans
Below you can find standard (non-urgent) and expedited (urgent) prior authorization request metrics for our covered Medicare Advantage members in 2025.
Standard (Non-Urgent) Prior Authorization Requests
In 2025, we received a total of 29,660 standard (non-urgent) prior authorization requests for our covered Medicare Advantage members. 94.6% of those requests were approved.
The mean (average) time it took to make standard prior authorization decisions was 3.35 days.
The median (middle) time it took to make standard prior authorization decisions was 0.85 days.
Standard (Non-Urgent) Prior Authorization Requests by the Numbers
| How Many Times This Happened | Out of Total Requests | Percentage | |
|---|---|---|---|
| Request Approved | 28,066 | 29,660 | 94.6% |
| Request Denied | 1,594 | 29,660 | 5.4% |
| Request Approved After Timeframe was Extended | 0 | 29,660 | 0% |
| Request Approved Only After Appeal | 368 | 462 | 79.7% |
Expedited (Urgent) Prior Authorization Requests
In 2025, we received a total of 1,096 expedited (urgent) prior authorization requests for our covered Medicare Advantage members. 98.3% of those requests were approved.
The mean (average) time it took to make expeditated prior authorization decisions was 0.82 days.
The median (middle) time it took to make expedited prior authorization decisions was 0.16 days.
Expedited (Urgent) Prior Authorization Requests by the Numbers
| How Many Times This Happened | Out of Total Requests | Percentage | |
|---|---|---|---|
| Request Approved | 1,077 | 1,096 | 98.3% |
| Request Denied | 19 | 1,096 | 1.7% |
| Request Approved After Timeframe was Extended |
0 | 1,096 | 0% |