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Cardinal Care Managed Care: (800) 424-4518

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CMS-0057 Prior Authorization Annual Reporting

2025 Prior Authorization Guide

MHVA Cardinal Care Medicaid Prior Authorization Report 2025

Prior Authorization Statistics	Molina Healthcare Inc Percentage
The percentage of STANDARD prior authorization requests that were approved, aggregated for all items and services.	92%
The percentage of STANDARD prior authorization requests that were denied, aggregated for all items and services.	8%
The percentage of STANDARD prior authorization requests that were approved after an appeal, aggregated for all items and services.	16%
The percentage of EXPEDITED prior authorization requests that were approved after an appeal, aggregated for all items and services.	20%
The percentage of STANDARD prior authorization requests for which the review timeframe was extended, and the request was approved, aggregated for all items and services.	58%
The percentage of EXPEDITED prior authorization requests for which the review timeframe was extended, and the request was approved, aggregated for all items and services.	66%
The percentage of EXPEDITED prior authorization requests that were approved, aggregated for all items and services.	95%
The percentage of EXPEDITED prior authorization requests that were denied, aggregated for all items and services.	5%
	Timing
Average time that elapsed between the submission of a request and a determination by the payor, plan or issuer, for STANDARD prior authorizations, aggregated for all items and services. (Measured in days)	6
Median time that elapsed between the submission of a request and a determination by the payor, plan, issuer, for STANDARD prior authorizations, aggregated for all items and services. (Measured in days)	5
Average time that elapsed between the submission of a request and a decision by the payor, plan or issuer, for EXPEDITED prior authorizations, aggregated for all items and services. (Measured in hours)	25
Median time that elapsed between the submission of a request and a decision by the payor, plan, issuer, for EXPEDITED prior authorizations, aggregated for all items and services. (Measured in hours)	17