Organization Detail
South Country Health Alliance
3 plans across 1 state · Medicare AdvantageMedicaid MCO
South Country Health Alliance reported prior authorization metrics for 3 Medicare Advantage, Medicaid MCO plans across 1 state under CMS rule CMS-0057-F for calendar year 2025. The average standard prior authorization denial rate was 0.4%, below the national average of 11.8%. When patients or providers appealed denied prior authorizations, 50% of appeals were overturned on average. Standard prior authorization decisions took an average of 2.1 days.
0.4%
South Country Health Alliance Denial Rate
standard, avg across 3 plans
11.8%
National Average
all reporting plans
-11.4%
vs. National
below average
MN3 plans
| Plan | Requests | Approved | Denied | Appr % | Denial % ▼ | Appeals | Overturn % | Denied Appeal % | Appr Ext % | Denied Ext % | Mean Days | Med Days |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| South Country Health Alliance SeniorCare Complete (H2419)Medicare Advantage | — | — | — | 99.0% | 1.0% | — | — | — | — | — | 2.0 | — |
| South Country Health Alliance Medicaid (MN)Medicaid MCO | — | — | — | 99.7% | 0.3% | — | 50.0% | 50.0% | — | — | 2.3 | — |
| South Country Health Alliance AbilityCare (H5703)Medicare Advantage | — | — | — | 100.0% | 0.0% | — | — | — | — | — | 2.0 | — |