Please read your Member Handbook. It tells you:
- About your benefits and what is covered
- How to get the services you need, including special health care needs
- Your rights and responsibilities as a member
Read your Member Handbook today!
Link to the Change Control Record.
CMS-0057 Prior Approval Annual Report
We want you to know how prior approval requests are handled. The Prior Approval Member Guide explains how requests are reviewed, how long decisions take and which services need prior approval.
Prior Approval Member Guide
Below is a summary of prior approval activity for South Carolina Medicaid.
South Carolina Medicaid Prior Authorization Report 2025
| Prior Authorization Statistics |
Molina Healthcare Inc
Percentage
|
| The percentage of STANDARD prior authorization requests that were approved, aggregated for all items and services. |
73% |
| The percentage of STANDARD prior authorization requests that were denied, aggregated for all items and services. |
27% |
| The percentage of STANDARD prior authorization requests that were approved after an appeal, aggregated for all items and services. |
18% |
| The percentage of EXPEDITED prior authorization requests that were approved after an appeal, aggregated for all items and services. |
16% |
| The percentage of STANDARD prior authorization requests for which the review timeframe was extended, and the request was approved, aggregated for all items and services. |
58% |
| The percentage of EXPEDITED prior authorization requests for which the review timeframe was extended, and the request was approved, aggregated for all items and services. |
50% |
| The percentage of EXPEDITED prior authorization requests that were approved, aggregated for all items and services. |
89% |
| The percentage of EXPEDITED prior authorization requests that were denied, aggregated for all items and services. |
11% |
|
Timing |
| Average time that elapsed between the submission of a request and a determination by the payor, plan or issuer, for STANDARD prior authorizations, aggregated for all items and services. (Measured in days) |
8 |
| Median time that elapsed between the submission of a request and a determination by the payor, plan, issuer, for STANDARD prior authorizations, aggregated for all items and services. (Measured in days) |
9 |
| Average time that elapsed between the submission of a request and a decision by the payor, plan or issuer, for EXPEDITED prior authorizations, aggregated for all items and services. (Measured in hours) |
21 |
| Median time that elapsed between the submission of a request and a decision by the payor, plan, issuer, for EXPEDITED prior authorizations, aggregated for all items and services. (Measured in hours) |
20 |
|
