Organization Detail
Community Health Plan of Washington
1 plan across 1 state · Medicaid MCO
Community Health Plan of Washington reported prior authorization metrics for 1 Medicaid MCO plan across 1 state under CMS rule CMS-0057-F for calendar year 2025. Across those plans, Community Health Plan of Washington processed 117,265 standard prior authorization requests. The average standard prior authorization denial rate was 13.3%, above the national average of 11.8%. When patients or providers appealed denied prior authorizations, 50.1% of appeals were overturned on average. Standard prior authorization decisions took an average of 4 days.
13.3%
Community Health Plan of Washington Denial Rate
standard, avg across 1 plans
11.8%
National Average
all reporting plans
+1.5%
vs. National
near average
WA1 plan
| Plan | Requests | Approved | Denied | Appr % | Denial % ▼ | Appeals | Overturn % | Denied Appeal % | Appr Ext % | Denied Ext % | Mean Days | Med Days |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Community Health Plan of Washington (Apple Health Medicaid)Medicaid MCO | 117,265 | 101,634 | 15,631 | 86.7% | 13.3% | 1,973 | 50.1% | 49.9% | 100.0% | 0.0% | 4.0 | 1.9 |
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