Filing · f0263
Highmark Medicare Advantage contract H3916
Highmark · Medicare Advantage · H3916 · Jan 1, 2025 - Dec 31, 2025
In 2025 this plan received 463,352 standard prior authorization requests and denied 3.9% of them. The median for Medicare Advantage plans of comparable size is 10.9%.
Standard denial rate
3.9%
463,352 standard requests, 18,072 denied.
77.9% of appealed denials were overturned.
Requests and outcomes
| Total | Approved | Denied | Denial rate | |
|---|---|---|---|---|
| Standard | 463,352 | 445,280 | 18,072 | 3.9% |
| Expedited | 81,341 | 74,476 | 6,865 | 8.4% |
| Extended review, approved | 38,884 | |||
This payer also printed its own standard denial rate: 4.0%. The rate above is computed from the published counts, so the two can be compared.
Appeals of standard denials
| Appeals filed | 1,333 |
| Denials overturned | 1,039 |
| Overturn rate | 77.9% |
Turnaround
| Mean | Median | |
|---|---|---|
| Standard | — | — |
| Expedited | — | — |