Filing · f0262
Contract H9678
Healthfirst · Medicare Advantage · NY · H9678 ·
In 2025 this plan received 11,134 standard prior authorization requests and denied 10.3% of them. The median for Medicare Advantage plans of comparable size is 10.5%.
Standard denial rate
10.3%
11,134 standard requests, 1,145 denied.
92.8% of appealed denials were overturned.
Requests and outcomes
| Total | Approved | Denied | Denial rate | |
|---|---|---|---|---|
| Standard | 11,134 | 9,989 | 1,145 | 10.3% |
| Expedited | 207 | 175 | 32 | 15.5% |
| Extended review, approved | 1 | |||
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 | 166 |
| Denials overturned | 154 |
| Overturn rate | 92.8% |
Turnaround
| Mean | Median | |
|---|---|---|
| Standard | 1.5 d | 0.0 d |
| Expedited | — | — |