State Detail

New Jersey

4 plans reporting · CY 2025

Across 4 plans reporting in New Jersey, standard prior authorization denial rates range from 0.5% to 17.5%, averaging 9.7%. Among plans reporting appeal outcomes, 70.4% 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
Wellcare Medicare Advantage (H0913)Medicare Advantage	Centene Corporation	42,739	35,256	7,483	82.5%	17.5%	315	96.5%	3.5%	0.0%	100.0%	5.0	2.0	11,275	10,684	591	94.8%	5.2%	105	99.0%	1.0%	0.0%	100.0%	0.0	0.0	View source ↗
Horizon Blue Cross Blue Shield of New Jersey
Horizon NJ FamilyCare - Medicaid MCOMedicaid MCO	Horizon Blue Cross Blue Shield of New Jersey	—	—	—	83.1%	16.9%	—	24.6%	75.4%	96.7%	3.3%	7.0	5.0	—	—	—	90.7%	9.3%	—	—	—	—	—	3.0	1.0	View source ↗
Horizon NJ TotalCare - HMO D-SNP (Medicare Advantage)Medicare Advantage	Horizon Blue Cross Blue Shield of New Jersey	—	—	—	96.1%	3.9%	—	64.1%	35.9%	98.1%	1.9%	6.0	4.0	—	—	—	99.8%	0.2%	—	—	—	—	—	2.0	1.0	View source ↗
Horizon Braven Health - Medicare AdvantageMedicare Advantage	Horizon Blue Cross Blue Shield of New Jersey	—	—	—	99.5%	0.5%	—	96.2%	3.8%	99.3%	0.7%	3.0	2.0	—	—	—	99.8%	0.2%	—	—	—	—	—	1.0	1.0	View source ↗