Filing · f0272

Highmark QHP (federal Marketplace) - Pennsylvania

Highmark · Marketplace QHP · PA · Jan 1, 2025 - Dec 31, 2025

In 2025 this plan received 77,677 standard prior authorization requests and denied 6.1% of them. The median for Marketplace QHP plans of comparable size is 18.3%. One check flagged this filing.

Standard denial rate

6.1%

77,677 standard requests, 4,716 denied. 54.0% of appealed denials were overturned.

Requests and outcomes

	Total	Approved	Denied	Denial rate
Standard	77,677	72,961	4,716	6.1%
Expedited	13,598	12,455	1,143	8.4%

This payer also printed its own standard denial rate: 6.0%. The rate above is computed from the published counts, so the two can be compared.

Appeals of standard denials

Appeals filed	50
Denials overturned	27
Overturn rate	54.0%

Turnaround

	Mean	Median
Standard	0.4 d	0.0 d
Expedited	11.8 h	0.0 h

What the checks found

warnexpedited_slower_than_standard

expedited mean 11.8h exceeds standard mean 0.43d (10h)

Highmark Medicare Advantage contract H3916	3.9%
Highmark Medicare Advantage contract H3957	3.3%
Highmark Medicare Advantage contract H5106	5.2%
Highmark Medicare Advantage contract H3384	1.5%
Highmark Medicaid - Delaware	1.5%
Highmark Medicare Advantage contract H8166	4.1%
Highmark Medicare Advantage contract H5526	1.4%
Highmark QHP (federal Marketplace) - West Virginia	11.8%