Prior authorization statistics

Annual review of turn-around times and authorization approvals versus denials

2023 Timeliness reports for radiology, musculoskeletal, and physical medicine

Utilization Management and Pharmacy authorization turnaround time report

You can view a master list of services on our prior authorization page.

family cooking a meal

2023 Illinois ACA marketplace member approval and denial rates

Medical authorizations	255
Behavioral health authorizations	1
Total denied	34
Total approved	222
Approval rate	87%

Reason for denial	Number of authorizations
Benefit Exclusion	9
Failure to obtain prior authorization	2
Not medically necessary to use out-of-network	4
Not medically necessary	17
Inpatient level of care not necessary	2
Total denied	34

Pharmacy authorizations
Approved	58
Denied	53
Approval rate	53%

Pharmacy reason for denial
Criteria not met	14
Formulary alternatives available	5
Not covered	22
Plan exclusion	11
Total denied	53

Appeals	Total	Overturned
Medical	0	0
Pharmacy	1	0
Total	1	0