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CMS-0057 Prior Authorization Annual Reporting

2025 Prior Authorization Guide
Prior Authorization Lookup Tool

Senior Whole Health of New York Medicaid Prior Authorization Annual Report 2025

NY SWH Medicaid MLTSS 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.	87%
The percentage of STANDARD prior authorization requests that were denied, aggregated for all items and services.	13%
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.	0%
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.	35%
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.	NA
The percentage of EXPEDITED prior authorization requests that were approved, aggregated for all items and services.	87%
The percentage of EXPEDITED prior authorization requests that were denied, aggregated for all items and services.	13%
	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)	3
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)	1
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)	79
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)	43

SWHNY FIDE 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.	100%
The percentage of STANDARD prior authorization requests that were denied, aggregated for all items and services.	0%
The percentage of STANDARD prior authorization requests that were approved after an appeal, aggregated for all items and services.	NA
The percentage of EXPEDITED prior authorization requests that were approved after an appeal, aggregated for all items and services.	NA
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.	NA
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.	NA
The percentage of EXPEDITED prior authorization requests that were approved, aggregated for all items and services.	NA
The percentage of EXPEDITED prior authorization requests that were denied, aggregated for all items and services.	NA
	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)	5
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)	3
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)	NA
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)	NA

Senior Whole Health of New York Medicare Prior Authorization Annual Report 2025

H5992 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.	30%
The percentage of EXPEDITED prior authorization requests that were approved after an appeal, aggregated for all items and services.	100%
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.	38%
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.	0%
The percentage of EXPEDITED prior authorization requests that were approved, aggregated for all items and services.	88%
The percentage of EXPEDITED prior authorization requests that were denied, aggregated for all items and services.	12%
	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)	2
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)	1
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)	18
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