To comply with the CMS Interoperability and Prior Authorization final rule, MCCMH is required to annually report aggregated prior authorization metrics on our website. Publicly reporting these metrics promotes transparency and accountability, helps patients understand prior authorization processes, and enables providers to evaluate payer performance. In addition, metrics can be used to compare plans, programs, and payers. For questions on the data below, contact: [email protected].
PRIOR AUTHORIZATION METRICS
FY 2025 Prior Authorization Metrics
| Total Service Requests | 48,403 |
| Approved as Requested | 89% |
| Partially Denied | 6.1% |
| Denied | 4.9% |
| Decision overturned after appeal | 3.5% |
Timeliness
| Completed in 1-3 days | 50% |
| Completed in 3-5 days | 25% |
| Completed in 5-7 days | 20% |
| Completed in 7-14 days | 5% |