Filing · f0265
Highmark Medicare Advantage contract H5106
Highmark · Medicare Advantage · H5106 · Jan 1, 2025 - Dec 31, 2025
In 2025 this plan received 41,018 standard prior authorization requests and denied 5.2% of them. The median for Medicare Advantage plans of comparable size is 10.9%.
Standard denial rate
5.2%
41,018 standard requests, 2,117 denied.
83.9% of appealed denials were overturned.
Requests and outcomes
| Total | Approved | Denied | Denial rate | |
|---|---|---|---|---|
| Standard | 41,018 | 38,901 | 2,117 | 5.2% |
| Expedited | 23,397 | 21,986 | 1,411 | 6.0% |
| Extended review, approved | 2,189 | |||
This payer also printed its own standard denial rate: 5.0%. The rate above is computed from the published counts, so the two can be compared.
Appeals of standard denials
| Appeals filed | 199 |
| Denials overturned | 167 |
| Overturn rate | 83.9% |
Turnaround
| Mean | Median | |
|---|---|---|
| Standard | — | — |
| Expedited | — | — |