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. Figures are reported separately for each service type, with aggregate totals across all items and services in the final column.
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)
Metrics by service type
| Metric | TFC Therapeutic Foster Care | TBS Therapeutic Behavioral Services | DTI Day Treatment Intensive | DTR Day Rehabilitation | SUD Residential Substance Use Disorder Residential Treatment | ACT / FACT Assertive Community Treatment or Forensic Assertive Community Treatment | IHBS Intensive Home-Based Services | All services |
|---|---|---|---|---|---|---|---|---|
| Prior authorization requests received (standard) | 0 | 303 | 0 | 0 | 5,914 | 0 | 2,089 | 8,306 |
| Prior authorizations approved | 0 | 301 | 0 | 0 | 5,914 | 0 | 2,089 | 8,304 |
| Percentage of requests approved | N/A | 99.34% | N/A | N/A | 100% | N/A | 100% | 99.98% |
| Prior authorizations denied | 0 | 2 | 0 | 0 | 0 | 0 | 0 | 2 |
| Percentage of requests denied | N/A | 0.66% | N/A | N/A | 0% | N/A | 0% | 0.02% |
| Prior authorizations approved after appeal | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 (0%) |
| Prior authorizations for which the review timeframe was extended and the request was approved | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 (0%) |
| Expedited prior authorizations received | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Expedited prior authorizations approved | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 (N/A) |
| Expedited prior authorizations denied | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 (N/A) |
| Average timeframe from submission to determination — standard requests | N/A | 4.93 business days | N/A | N/A | Not reported | N/A | 0 business days | 4.93 business days |
| Median timeframe from submission to determination — standard requests | N/A | Not reported | N/A | N/A | Not reported | N/A | 0 business days | Not reported |
| Average and median timeframe from submission to determination — expedited requests | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
Service type abbreviations
TFC
Therapeutic Foster Care
TBS
Therapeutic Behavioral Services
DTI
Day Treatment Intensive
DTR
Day Rehabilitation
SUD Residential
Substance Use Disorder Residential Treatment
ACT / FACT
Assertive Community Treatment / Forensic Assertive Community Treatment
IHBS
Intensive Home-Based Services
N/A indicates that no requests of that type were received during the reporting period. Total standard and expedited prior authorization requests received (combined volume): 8,306. Questions about this data may be directed to Riverside University Health System – Behavioral Health.