State Detail
New Hampshire
4 plans reporting · CY 2025
Across 4 plans reporting in New Hampshire, standard prior authorization denial rates range from 7.0% to 23.1%, averaging 12.8%. Among plans reporting appeal outcomes, 60.3% 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 |
| Centene Corporation | ||||||||||||||||||||||||||
| Ambetter from NH Healthy FamiliesExchange Plans | Centene Corporation | 15,855 | 12,191 | 3,664 | 76.9% | 23.1% | 604 | 81.3% | 18.7% | 0.0% | 100.0% | 2.0 | 0.0 | 612 | 423 | 189 | 69.1% | 30.9% | 28 | 82.1% | 17.9% | 0.0% | 100.0% | 1.0 | 0.0 | View source ↗ |
| WellSense Health Plan (formerly BMC HealthNet Plan) | ||||||||||||||||||||||||||
| WellSense Health Plan - New Hampshire MedicaidMedicaid MCO | WellSense Health Plan (formerly BMC HealthNet Plan) | 25,431 | 22,547 | 2,884 | 89.0% | 11.0% | 59 | 47.0% | 53.0% | — | — | 3.6 | 1.0 | 909 | 828 | 81 | 91.0% | 9.0% | 4 | 25.0% | 75.0% | — | — | 0.7 | 0.1 | View source ↗ |
| WellSense Health Plan - New Hampshire Clarity (QHP)Exchange Plans | WellSense Health Plan (formerly BMC HealthNet Plan) | 1,554 | 1,394 | 160 | 90.0% | 10.0% | 3 | 33.0% | 67.0% | — | — | 1.6 | 0.1 | 97 | 85 | 12 | 88.0% | 12.0% | 1 | 0.0% | 100.0% | — | — | 0.9 | 0.3 | View source ↗ |
| WellSense Health Plan - New Hampshire Medicare (MA)Medicare Advantage | WellSense Health Plan (formerly BMC HealthNet Plan) | 11,569 | 10,741 | 828 | 93.0% | 7.0% | 10 | 80.0% | 20.0% | — | — | 3.0 | 0.4 | 564 | 532 | 32 | 94.0% | 6.0% | 1 | 100.0% | 0.0% | — | — | 0.8 | 0.2 | 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