PA decision rate
98.2%
−1.8 ptsvs prior
PA approval rate
83.8%
−3.2 ptsvs prior
Target: 91.0%
PA denial rate
16.2%
+3.2 ptsvs prior
Target: 9.0%
PA turnaround
2.5 d
+0.4 dvs prior
Target: 3.5 d
P90 7.0 days
Pending over 5 days
2.0 d
Target: 3.5 d
7 pending in total
Appeal overturn rate
15.4%
Target: 91.0%
Where every PA landed
Status distribution for submissions in this window
383 submissions
50
313
- Denied5013.1%
- Approved31381.7%
- Appealed133.4%
- Submitted71.8%
16.2% of decided PAs were denied. Denials that get appealed are overturned 15% of the time, so appealing is usually worth the effort.
Turnaround trend
Average business days from submission to decision
Turnaround climbs whenever submission volume spikes, which is the signature of a fixed-capacity PA team rather than a payer problem.
Why PAs get denied
Denial reasons by frequency
Medical necessity not established is the leading denial reason, and most of it is fixable at intake.
Payer difficulty ranking
21 rows
| Harborlight Health Partners | 19 | 72.2 | 27.8 | 4.7 | 47 |
| Bayview Union Trust | 17 | 75 | 25 | 5.3 | 47 |
| Alta Vista Medicare Select | 19 | 81.3 | 18.8 | 3.5 | 46 |
| Central Valley Wellness | 26 | 83.3 | 16.7 | 3.5 | 45 |
| Vantage Care Network | 33 | 93.1 | 6.9 | 5.5 | 41 |
| Silver Mesa Part D | 15 | 92.9 | 7.1 | 2.1 | 38 |
| Crestway PBM Services | 16 | 100 | 0 | 2.8 | 37 |
| Lantana Family Plan | 16 | 75 | 25 | 3.5 | 37 |
| Sunridge Medicare Advantage | 25 | 100 | 0 | 2.1 | 35 |
| Pinecrest Municipal Plan | 21 | 85.7 | 14.3 | 3.6 | 33 |
| Meridian Health Plan | 15 | 84.6 | 15.4 | 7.8 | 32 |
| Solstice Health Cooperative | 13 | 69.2 | 30.8 | 2 | 29 |
| Marina Bay Employer Health | 17 | 80 | 20 | 2.8 | 27 |
| Keystone Rx Managed | 12 | 91.7 | 8.3 | 1.7 | 26 |
| Optima Scripts | 15 | 85.7 | 14.3 | 4.8 | 24 |
| Pacifica Blue Shield Alliance | 23 | 77.3 | 22.7 | 3.1 | 23 |
| Redwood Community Health | 23 | 87 | 13 | 4.4 | 22 |
| Golden State Advantage | 13 | 76.9 | 23.1 | 2.6 | 22 |
| Medi-Cal Managed Care | 15 | 100 | 0 | 1.4 | 15 |
| Cascade Employer Group | 18 | 94.4 | 5.6 | 1.8 | 13 |
| Foothill Regional Care | 12 | 100 | 0 | 2.2 | 11 |
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Pending PA worklist
7 rows
| PA-01893 | Mateo Solano | Central Valley Wellness | Infusion Sets | Sep 17 | 6.7 | Junia Petrossian |
| PA-01909 | Nikolai Marchetti | Pacifica Blue Shield Alliance | Compleat Pediatric | Sep 18 | 5.2 | Junia Petrossian |
| PA-01917 | Soren Vasquez | Marina Bay Employer Health | Kate Farms Standard 1.4 | Sep 20 | 3.3 | Wren Batiste |
| PA-01919 | Devon Moreau | Optima Scripts | Beta Pharmacy Kit | Sep 23 | 0.8 | Sasha Kowalczyk |
| PA-01921 | Verena Okonkwo | Sunridge Medicare Advantage | Kate Farms Standard 1.4 | Sep 23 | 0.6 | Mateo Delacroix |
| PA-01920 | Marisol Aldridge | Vantage Care Network | Cartridges/Reservoirs | Sep 23 | 0.3 | Junia Petrossian |
| PA-01922 | Petra Castellanos | Vantage Care Network | Kate Farms Standard 1.4 | Sep 23 | 0.3 | Wren Batiste |
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