CMS-0057 Prior Authorization Annual Reporting
ConnectiCare Prior Authorization Annual Report 2025
H3276 Prior Authorization Report 2025| Prior Authorization Statistics | Molina Clinical Services, LLC Percentage |
|---|---|
| The percentage of STANDARD prior authorization requests that were approved, aggregated for all items and services. | 96% |
| The percentage of STANDARD prior authorization requests that were denied, aggregated for all items and services. | 4% |
| 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. | 100% |
| The percentage of EXPEDITED prior authorization requests that were denied, aggregated for all items and services. | 0% |
| 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) | 1 |
| 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) | 0 |
| 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) | 2 |
| 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) | 2 |
H3528 Prior Authorization Report 2025
| Prior Authorization Statistics | Molina Clinical Services, LLC Percentage |
|---|---|
| The percentage of STANDARD prior authorization requests that were approved, aggregated for all items and services. | 96% |
| The percentage of STANDARD prior authorization requests that were denied, aggregated for all items and services. | 4% |
| The percentage of STANDARD prior authorization requests that were approved after an appeal, aggregated for all items and services. | 89% |
| 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. | 100% |
| 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. | 100% |
| The percentage of EXPEDITED prior authorization requests that were approved, aggregated for all items and services. | 100% |
| The percentage of EXPEDITED prior authorization requests that were denied, aggregated for all items and services. | 0% |
| 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) | 1 |
| 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) | 0 |
| 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) | 16 |
| 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) | 2 |
