This report shows how prior authorization requests are handled, such as how many were approved or denied and how quickly decisions were made. To find out if a specific service needs prior authorization, members and providers should check the plan’s Prior Authorization Guide or use the Prior Authorization Lookup Tool.
Marketplace Prior Authorization Annual 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. |
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. |
50% |
| The percentage of EXPEDITED prior authorization requests that were approved after an appeal, aggregated for all items and services. |
46% |
| 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. |
53% |
| 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. |
57% |
| The percentage of EXPEDITED prior authorization requests that were approved, aggregated for all items and services. |
90% |
| The percentage of EXPEDITED prior authorization requests that were denied, aggregated for all items and services. |
10% |
|
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) |
4 |
| 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) |
23 |
|
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