Prior Authorization Metrics Summary
Pursuant to a market specific regulatory mandate, partially approved authorization determinations are categorized as Approved Authorizations within this report.
Standard (non-urgent)
Metric Name | How many times this happened | Out of total requests | Percentage |
|---|---|---|---|
Requests Approved | 33,808 | 44,871 | 75.34% |
Requests Denied | 11,063 | 44,871 | 24.66% |
Request Approved Only After Time for Review was extended | 61 | 44,871 | 0.14% |
Request Approved Only After Appeal | 793 | 1,415 | 56.04% |
Metric Name | Average Time | Median Time |
|---|---|---|
Standard (non-urgent) Prior Authorization Requests | 4 days | 4 days |
In 2025, Nebraska Total Care received a total of 44,871 standard (non-urgent) prior authorization requests for our covered patients. 75.34% of those requests were approved.
- 33,808 Requests approved
- 11,063 Requests denied
- 61 Requests approved only after time for review was extended
- 793 Requests approved only after appeal
Expedited (urgent)
Metric Name | How many times this happened | Out of total requests | Percentage |
|---|---|---|---|
Requests Approved | 883 | 1,226 | 72.02% |
Requests Denied | 343 | 1,226 | 27.98% |
Request Approved Only After Time for Review was extended | 0 | 1,226 | 0.00% |
Request Approved Only After Appeal | 26 | 45 | 57.78% |
Metric Name | Average Time | Median Time |
|---|---|---|
Expedited (urgent) Prior Authorization Requests | 1 day | 1 day |
In 2025, Nebraska Total Care received a total of 1,226 expedited (urgent) prior authorization requests for our covered patients. 72.02% of those requests were approved.
- 883 Requests approved
- 343 Requests denied
- 0 Requests approved only after time for review was extended
- 26 Requests approved only after appeal