Evidence file · prior-authorization-humana-sc-sc-state-medicaid-2025
Humana
SC (state Medicaid) · Medicaid · 2025 · South Carolina
The takeaway
What this record says—and what it does not
This Medicaid reporting unit denied 10.9 of every 100 standard prior-authorization requests in 2025.
- Compared with what?
- That is near the 10.9% median among 9 records in this library with the same program, year, and metric. This is a directional comparison, not a quality grade.
- How could I use this?
- Use it to ask the payer about its review process, compare like reporting units, or identify a pattern worth deeper reporting, research, or regulatory review.
- What can’t I conclude?
- It is an aggregate rate. It does not identify a service, explain a particular decision, prove that a denial was wrongful, or describe a different plan or program.
- Standard requests
- 14,667 count
- Standard requests denied
- 10.86%
- Standard requests denied
- 1,593 count
- Appeals
- 48 count
- Appeals overturned
- 43.75%
- Expedited requests
- 3,799 count
- Expedited requests denied
- 59.44%
Scope and limits
- Family
- prior-authorization
- Scope
- Contract-level CMS-0057-F prior authorization disclosure
- Status
- published
- Missing fields
- None identified in normalized fields
Artifact and version
- Captured
- 2026-07-17T21:57:19.215Z
- SHA-256
- f1a886bffab79ab3181b3b6cc76e1ec2c9578211bde0d118d896b45ab6c6c03e
- Version
- f1a886bffab7
- Extraction
- Parsed from the checked source extraction and normalized by pipeline v1.
Citation and files
Humana SC (state Medicaid), CMS-0057-F prior authorization metrics, plan year 2025.
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