Filing · f0267
Highmark Medicare Advantage contract H5932
Highmark · Medicare Advantage · PA · H5932 · Jan 1, 2025 - Dec 31, 2025
In 2025 this plan received 7,010 standard prior authorization requests and denied 12.2% of them. The median for Medicare Advantage plans of comparable size is 10.9%. One check flagged this filing.
Standard denial rate
12.2%
7,010 standard requests, 857 denied.
72.3% of appealed denials were overturned.
Requests and outcomes
| Total | Approved | Denied | Denial rate | |
|---|---|---|---|---|
| Standard | 7,010 | 6,152 | 857 | 12.2% |
| Expedited | 11,889 | 10,887 | 1,002 | 8.4% |
| Extended review, approved | 4 | |||
This payer also printed its own standard denial rate: 12.0%. The rate above is computed from the published counts, so the two can be compared.
Appeals of standard denials
| Appeals filed | 440 |
| Denials overturned | 318 |
| Overturn rate | 72.3% |
Turnaround
| Mean | Median | |
|---|---|---|
| Standard | 4.7 d | 5.5 d |
| Expedited | — | — |
What the checks found
warnexpedited_exceeds_standard_volume
expedited volume 11,889 exceeds standard 7,010 (1.7x) - columns may be transposed