San Francisco Health Plan

San Francisco Health Plan 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, San Francisco Health Plan processed 62,848 standard prior authorization requests. The average standard prior authorization denial rate was 2%, below the national average of 11.8%. When patients or providers appealed denied prior authorizations, 54.6% of appeals were overturned on average. Standard prior authorization decisions took an average of 4.7 days.