Filing · f0269
Highmark Medicare Advantage contract H8166
Highmark · Medicare Advantage · H8166 · Jan 1, 2025 - Dec 31, 2025
In 2025 this plan received 27,105 standard prior authorization requests and denied 4.1% of them. The median for Medicare Advantage plans of comparable size is 10.9%.
Standard denial rate
4.1%
27,105 standard requests, 1,114 denied.
79.8% of appealed denials were overturned.
Requests and outcomes
| Total | Approved | Denied | Denial rate | |
|---|---|---|---|---|
| Standard | 27,105 | 25,991 | 1,114 | 4.1% |
| Expedited | 7,979 | 7,390 | 589 | 7.4% |
| Extended review, approved | 2,105 | |||
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 | 129 |
| Denials overturned | 103 |
| Overturn rate | 79.8% |
Turnaround
| Mean | Median | |
|---|---|---|
| Standard | — | — |
| Expedited | — | — |