Filing · f0264
Highmark Medicare Advantage contract H3957
Highmark · Medicare Advantage · H3957 · Jan 1, 2025 - Dec 31, 2025
In 2025 this plan received 98,307 standard prior authorization requests and denied 3.3% of them. The median for Medicare Advantage plans of comparable size is 10.9%.
Standard denial rate
3.3%
98,307 standard requests, 3,237 denied.
76.3% of appealed denials were overturned.
Requests and outcomes
| Total | Approved | Denied | Denial rate | |
|---|---|---|---|---|
| Standard | 98,307 | 95,070 | 3,237 | 3.3% |
| Expedited | 23,397 | 21,986 | 1,411 | 6.0% |
| Extended review, approved | 4,484 | |||
This payer also printed its own standard denial rate: 3.0%. The rate above is computed from the published counts, so the two can be compared.
Appeals of standard denials
| Appeals filed | 198 |
| Denials overturned | 151 |
| Overturn rate | 76.3% |
Turnaround
| Mean | Median | |
|---|---|---|
| Standard | — | — |
| Expedited | — | — |