Organization Detail
Centene / Wellcare
2 plans across 1 state · Medicare Advantage
Centene / Wellcare reported prior authorization metrics for 2 Medicare Advantage plans across 1 state under CMS rule CMS-0057-F for calendar year 2025. Across those plans, Centene / Wellcare processed 56,581 standard prior authorization requests. The average standard prior authorization denial rate was 11.4%, below the national average of 11.8%. When patients or providers appealed denied prior authorizations, 95.8% of appeals were overturned on average. Standard prior authorization decisions took an average of 3 days.
11.4%
Centene / Wellcare Denial Rate
standard, avg across 2 plans
11.8%
National Average
all reporting plans
-0.4%
vs. National
near average
OR2 plans
| Plan | Requests | Approved | Denied | Appr % | Denial % ▼ | Appeals | Overturn % | Denied Appeal % | Appr Ext % | Denied Ext % | Mean Days | Med Days |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Wellcare by Health Net Medicare Advantage (H5439)Medicare Advantage | 36,426 | 32,080 | 4,346 | 88.1% | 11.9% | 613 | 96.3% | 3.8% | 0.0% | 100.0% | 3.0 | 2.0 |
| Wellcare by Health Net Medicare Advantage (H6815)Medicare Advantage | 20,155 | 17,978 | 2,177 | 89.2% | 10.8% | 326 | 95.4% | 4.6% | 0.0% | 100.0% | 3.0 | 2.0 |