State Detail

North Carolina

5 plans reporting · CY 2025

Across 5 plans reporting in North Carolina, standard prior authorization denial rates range from 13.6% to 20.7%, averaging 15.6%. Among plans reporting appeal outcomes, 79.6% 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
Centene Corporation
Ambetter of North CarolinaExchange Plans	Centene Corporation	50,371	39,953	10,418	79.3%	20.7%	1,679	51.8%	48.2%	1.8%	98.2%	2.0	1.0	1,602	1,215	387	75.8%	24.2%	102	60.8%	39.2%	4.6%	95.4%	1.0	1.0	View source ↗
WellCare of North Carolina - Medicaid MCO (Centene)Medicaid MCO	Centene Corporation	146,958	124,779	22,179	84.9%	15.1%	1,138	78.3%	21.7%	0.1%	100.0%	5.0	1.0	4,346	4,170	176	96.0%	4.0%	24	75.0%	25.0%	0.0%	100.0%	1.0	0.0	View source ↗
Wellcare Medicare Advantage H1914Medicare Advantage	Centene Corporation	13,552	11,556	1,996	85.3%	14.7%	150	98.7%	1.3%	0.0%	100.0%	4.0	1.0	2,242	1,853	389	82.7%	17.4%	38	100.0%	0.0%	0.0%	100.0%	1.0	1.0	View source ↗
Carolina Complete Health - NC Medicaid MCO (Centene)Medicaid MCO	Centene Corporation	70,843	60,830	10,013	85.9%	14.1%	1,143	69.2%	30.8%	0.1%	99.9%	5.0	5.0	582	520	62	89.3%	10.7%	624	79.5%	20.5%	11.9%	88.1%	1.0	1.0	View source ↗
Wellcare Medicare Advantage H4073Medicare Advantage	Centene Corporation	8,937	7,725	1,212	86.4%	13.6%	108	100.0%	0.0%	0.0%	100.0%	4.0	1.0	1,129	935	194	82.8%	17.2%	21	95.2%	4.8%	0.0%	100.0%	1.0	1.0	View source ↗