Prior authorization metrics — 2025

In accordance with federal reporting requirements under 42 CFR 438.210(f) and DHCS Behavioral Health Information Notice (BHIN) 26-008, Riverside University Health System – Behavioral Health is required to publicly report annual prior authorization metrics. These metrics reflect our commitment to transparency, accountability, and timely access to care for Medi-Cal beneficiaries.

Reporting period: January 1, 2025 – December 31, 2025. Percentages are aggregated across all items and services.

Prior authorization metrics for calendar year 2025, listing each required data point and the corresponding response.
Data point	Response
1. A list of all items and services that require prior authorization	Intensive Home-Based Services (IHBS) Day Treatment Intensive (DTI) Day Rehabilitation (DTR) Therapeutic Behavioral Services (TBS) Therapeutic Foster Care (TFC) Substance Use Disorder (SUD) Residential Treatment Assertive Community Treatment / Forensic Assertive Community Treatment (ACT / FACT)
2. Total standard prior authorization requests received	8,306
3. The percentage of standard prior authorization requests that were approved, aggregated for all items and services	99.98%
4. The percentage of standard prior authorization requests that were denied, aggregated for all items and services	0.02%
5. The percentage of standard prior authorization requests that were approved after appeal, aggregated for all items and services	0%
6. The percentage of prior authorization requests where the timeframe for review was extended, and the request was approved, aggregated for all items and services	0%
7. Total expedited prior authorization requests received	0
8. The percentage of expedited prior authorization requests that were approved, aggregated for all items and services	N/A
9. The percentage of expedited prior authorization requests that were denied, aggregated for all items and services	N/A
10. Total standard and expedited prior authorization requests received (combined total volume)	8,306
11. The average and median time between submission and determination for standard prior authorizations	Average: 4.93 business days; Median: not reported
12. The average and median time between submission and determination for expedited prior authorizations	N/A

N/A indicates that no requests of that type were received during the reporting period. Questions about this data may be directed to Riverside University Health System – Behavioral Health.