Filing · f0266
Highmark Medicare Advantage contract H5526
Highmark · Medicare Advantage · H5526 · Jan 1, 2025 - Dec 31, 2025
In 2025 this plan received 25,925 standard prior authorization requests and denied 1.4% of them. The median for Medicare Advantage plans of comparable size is 10.9%.
Standard denial rate
1.4%
25,925 standard requests, 374 denied.
77.8% of appealed denials were overturned.
Requests and outcomes
| Total | Approved | Denied | Denial rate | |
|---|---|---|---|---|
| Standard | 25,925 | 25,551 | 374 | 1.4% |
| Expedited | 10,481 | 9,737 | 744 | 7.1% |
| Extended review, approved | 54 | |||
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 | 90 |
| Denials overturned | 70 |
| Overturn rate | 77.8% |
Turnaround
| Mean | Median | |
|---|---|---|
| Standard | — | — |
| Expedited | — | — |