Filing · f0262
Highmark Medicare Advantage contract H3384
Highmark · Medicare Advantage · H3384 · Jan 1, 2025 - Dec 31, 2025
In 2025 this plan received 39,409 standard prior authorization requests and denied 1.5% of them. The median for Medicare Advantage plans of comparable size is 10.9%.
Standard denial rate
1.5%
39,409 standard requests, 586 denied.
83.3% of appealed denials were overturned.
Requests and outcomes
| Total | Approved | Denied | Denial rate | |
|---|---|---|---|---|
| Standard | 39,409 | 38,823 | 586 | 1.5% |
| Expedited | 23,397 | 21,986 | 1,411 | 6.0% |
| Extended review, approved | 40 | |||
This payer also printed its own standard denial rate: 1.0%. The rate above is computed from the published counts, so the two can be compared.
Appeals of standard denials
| Appeals filed | 114 |
| Denials overturned | 95 |
| Overturn rate | 83.3% |
Turnaround
| Mean | Median | |
|---|---|---|
| Standard | — | — |
| Expedited | — | — |