State Detail
Tennessee
3 plans reporting · CY 2025
Across 3 plans reporting in Tennessee, standard prior authorization denial rates range from 12.8% to 22.8%, averaging 17.3%. Among plans reporting appeal outcomes, 67.0% 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 TennesseeExchange Plans | Centene Corporation | 104,566 | 80,766 | 23,800 | 77.2% | 22.8% | 3,238 | 68.5% | 31.5% | 1.3% | 98.7% | 2.0 | 1.0 | 2,475 | 2,063 | 412 | 83.3% | 16.6% | 148 | 62.8% | 37.2% | 3.4% | 96.6% | 1.0 | 0.0 | View source ↗ |
| Wellcare Medicare Advantage (H1416)Medicare Advantage | Centene Corporation | 106,623 | 89,358 | 17,265 | 83.8% | 16.2% | 1,252 | 95.0% | 5.0% | 0.0% | 0.0% | 4.0 | 2.0 | 14,735 | 12,387 | 2,348 | 84.1% | 15.9% | 252 | 92.9% | 7.1% | 0.0% | 0.0% | 1.0 | 1.0 | View source ↗ |
| UnitedHealth Group | ||||||||||||||||||||||||||
| UnitedHealthcare Commercial Plans - TennesseeExchange Plans | UnitedHealth Group | 10,521 | 9,010 | 1,350 | 85.6% | 12.8% | 189 | 37.6% | 62.4% | — | — | 1.6 | — | — | — | — | — | — | — | — | — | — | — | — | — | 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