State Detail
Colorado
3 plans reporting · CY 2025
Across 3 plans reporting in Colorado, standard prior authorization denial rates range from 8.2% to 27.0%, averaging 17.8%. Among plans reporting appeal outcomes, 37.3% of appealed denials are overturned. All data is from mandatory CMS-0057-F disclosures for calendar year 2025.
Plan Comparison
| Standard | Expedited | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Plan | Org | Requests | Approved | Denied | Appr % | Denial % ▼ | Appeals | Overturn % | Denied Appeal % | Appr Ext % | Denied Ext % | Mean Days | Med Days | Requests | Approved | Denied | Appr % | Denial % | Appeals | Overturn % | Denied Appeal % | Appr Ext % | Denied Ext % | Mean Days | Med Days | Source |
| Colorado Access | ||||||||||||||||||||||||||
| Colorado Access Medicaid MCO (RAE 3 & RAE 5)Medicaid MCO | Colorado Access | 16,654 | 15,284 | 1,370 | 91.8% | 8.2% | — | — | — | 25.3% | 74.7% | 1.9 | 1.0 | 17,006 | 15,849 | 1,157 | 93.2% | 6.8% | — | — | — | 47.4% | 52.6% | 21.1 | 3.0 | View source ↗ |
| The Cigna Group | ||||||||||||||||||||||||||
| Cigna Healthcare IFP FFEExchange Plans | The Cigna Group | — | — | — | 73.0% | 27.0% | — | 16.0% | 84.0% | — | — | 4.0 | 0.0 | — | — | — | 78.0% | 22.0% | — | — | — | — | — | 1.5 | 0.0 | View source ↗ |
| Cigna Health and Life Insurance Company - ColoradoExchange Plans | The Cigna Group | 59,553 | 47,959 | 10,785 | 80.5% | 18.1% | 845 | 58.6% | 41.4% | — | — | — | — | — | — | — | — | — | — | — | — | — | — | — | — | View source ↗ |
Standard Denial Rates by Plan
Appeals Analysis
Plans in the upper-right deny frequently and have high overturn rates — suggesting inappropriate denials.
Similar Denial Rates