Organization Detail

Kaiser Permanente

17 plans across 7 states · Medicare AdvantageMedicaid MCOCHIP

Kaiser Permanente reported prior authorization metrics for 17 Medicare Advantage, Medicaid MCO, CHIP plans across 7 states under CMS rule CMS-0057-F for calendar year 2025. Across those plans, Kaiser Permanente processed 949,592 standard prior authorization requests. The average standard prior authorization denial rate was 9%, below the national average of 11.8%. When patients or providers appealed denied prior authorizations, 45.8% of appeals were overturned on average. Standard prior authorization decisions took an average of 3.2 days.

9.0%

Kaiser Permanente Denial Rate

standard, avg across 17 plans

11.8%

National Average

all reporting plans

-2.8%

vs. National

below average

CA6 plans

Plan	Requests	Approved	Denied	Appr %	Denial % ▼	Appeals	Overturn %	Denied Appeal %	Appr Ext %	Denied Ext %	Mean Days	Med Days
Kaiser Permanente Southern California MA H0524Medicare Advantage	143,690	115,698	27,992	80.5%	19.5%	310	25.5%	74.5%	—	—	0.9	—
Kaiser Permanente Northern California MA H8794Medicare Advantage	39,581	35,095	4,486	88.7%	11.3%	129	40.3%	59.7%	—	—	1.3	—
Kaiser Permanente Southern California MA H8794Medicare Advantage	33,855	30,149	3,706	89.0%	10.9%	94	37.2%	62.8%	—	—	—	—
Kaiser Permanente Northern California MA H0524Medicare Advantage	144,514	129,300	15,214	89.5%	10.5%	369	36.9%	63.1%	—	—	1.6	—
Kaiser Permanente Northern California MedicaidMedicaid MCO	24,982	22,747	2,235	91.0%	8.9%	359	30.9%	69.1%	—	—	—	—
Kaiser Permanente Southern California MedicaidMedicaid MCO	56,689	53,067	3,622	93.6%	6.4%	234	24.4%	75.6%	—	—	—	—

CO3 plans

Plan	Requests	Approved	Denied	Appr %	Denial % ▼	Appeals	Overturn %	Denied Appeal %	Appr Ext %	Denied Ext %	Mean Days	Med Days
Kaiser Permanente Colorado MA H0630Medicare Advantage	69,309	62,629	6,680	90.4%	9.6%	143	66.4%	33.6%	—	—	5.3	1.1
Kaiser Permanente Colorado CHIPCHIP	1,450	1,314	136	90.6%	9.4%	2	50.0%	50.0%	—	—	—	—
Kaiser Permanente Colorado MA H3138Medicare Advantage	876	802	74	91.5%	8.4%	3	100.0%	0.0%	—	—	7.0	3.1

GA1 plan

Plan	Requests	Approved	Denied	Appr %	Denial % ▼	Appeals	Overturn %	Denied Appeal %	Appr Ext %	Denied Ext %	Mean Days	Med Days
Kaiser Permanente Georgia MA H1170Medicare Advantage	51,523	49,908	1,615	96.9%	3.1%	27	51.9%	48.1%	—	—	5.5	4.8

HI3 plans

Plan	Requests	Approved	Denied	Appr %	Denial % ▼	Appeals	Overturn %	Denied Appeal %	Appr Ext %	Denied Ext %	Mean Days	Med Days
Kaiser Permanente Hawaii MA H1230Medicare Advantage	22,497	20,903	1,594	92.9%	7.1%	11	63.6%	36.4%	—	—	1.9	—
Kaiser Permanente Hawaii MedicaidMedicaid MCO	10,185	9,924	261	97.4%	2.6%	1	0.0%	100.0%	—	—	—	—
Kaiser Permanente Hawaii MA H2704Medicare Advantage	77	77	0	100.0%	0.0%	0	—	—	—	—	—	—

MD1 plan

Plan	Requests	Approved	Denied	Appr %	Denial % ▼	Appeals	Overturn %	Denied Appeal %	Appr Ext %	Denied Ext %	Mean Days	Med Days
Kaiser Permanente Mid-Atlantic MA H2172Medicare Advantage	90,494	85,512	4,982	94.5%	5.5%	104	69.2%	30.8%	—	—	0.1	0.0

OR2 plans

Plan	Requests	Approved	Denied	Appr %	Denial % ▼	Appeals	Overturn %	Denied Appeal %	Appr Ext %	Denied Ext %	Mean Days	Med Days
Kaiser Permanente Northwest Oregon MedicaidMedicaid MCO	12,578	10,009	2,569	79.6%	20.4%	185	20.0%	80.0%	—	—	6.4	3.9
Kaiser Permanente Northwest MA H9003Medicare Advantage	62,374	54,540	7,834	87.4%	12.6%	154	46.8%	53.3%	—	—	3.7	0.8

WA1 plan

Plan	Requests	Approved	Denied	Appr %	Denial % ▼	Appeals	Overturn %	Denied Appeal %	Appr Ext %	Denied Ext %	Mean Days	Med Days
Kaiser Permanente Washington MA H5050Medicare Advantage	184,918	173,558	11,360	93.9%	6.1%	445	70.3%	29.7%	—	—	1.0	0.2

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