As part of our ongoing commitment to transparency and high-quality service, Health Plan is making prior authorization (PA) information more accessible for our Medi-Cal provider community. This page includes our annual PA data, along with the HPSJ–MVHP Medi-Cal Pre-Authorization Required List to support timely and accurate submission of authorization requests.
- The Pre-Auth Required List will be reviewed and updated quarterly at minimum.
- Prior authorization metrics will be published annually, consistent with state and federal reporting standards, including MCPAR requirements.
Our most recent Managed Care Program Annual Report (MCPAR), including downloadable files, is provided below for your reference:
January 1, 2025 – December 31, 2025
| Metric |
Total |
Total standard Prior Authorization requests received
(Enter total count) |
131761 |
Total expedited Prior Authorization requests received
(Enter total count) |
44446 |
Total standard and expedited Prior Authorization requests received
(Enter total count) |
176207 |
Percentage of standard Prior Authorization requests that were approved
(Enter percentage) |
94.97% |
Percentage of standard Prior Authorization requests that were denied
(Enter percentage) |
5.03% |
Percentage of standard Prior Authorization requests approved after appeal
(Enter percentage) |
0.06% |
Average time to decision for standard Prior Authorizations
(Enter number of days) |
6.95 |
Median time to decision on standard Prior Authorizations
(Enter number of days) |
6.98 |
Percentage of expedited Prior Authorization requests that were approved
(Enter percentage) |
95.37% |
Percentage of expedited Prior Authorization requests that were denied
(Enter percentage) |
4.63% |
Average time to decision for expedited Prior Authorizations
(Enter number of hours) |
26.27 |
Median time to decision for expedited Prior Authorizations
(Enter number of hours) |
23.73 |
Percentage of total Prior Authorization requests approved with extended timeframe
(Enter percentage) |
1.47% |
