Filing · f0261
Contract H5989
Healthfirst · Medicare Advantage · NY · H5989 ·
In 2025 this plan received 52,494 standard prior authorization requests and denied 10.0% of them. The median for Medicare Advantage plans of comparable size is 10.5%.
Standard denial rate
10.0%
52,494 standard requests, 5,228 denied.
90.3% of appealed denials were overturned.
Requests and outcomes
| Total | Approved | Denied | Denial rate | |
|---|---|---|---|---|
| Standard | 52,494 | 47,266 | 5,228 | 10.0% |
| Expedited | 674 | 559 | 115 | 17.1% |
| Extended review, approved | 0 | |||
This payer also printed its own standard denial rate: 10.0%. The rate above is computed from the published counts, so the two can be compared.
Appeals of standard denials
| Appeals filed | 507 |
| Denials overturned | 458 |
| Overturn rate | 90.3% |
Turnaround
| Mean | Median | |
|---|---|---|
| Standard | 3.0 d | 0.3 d |
| Expedited | — | — |