Anthem Elevance MA

Contract: H2819 · Plan type: HMO

Evidence lead: Ranks four through six · Large request-volume cohort

Anthem Elevance MA: One of the ten largest authorization workloads

The 750,000 recorded requests place this contract in the highest-volume tier. Its request-volume rank is #4 of 37. Volume shows the denominator behind approvals and denials; it is not a measure of plan quality, membership, benefit breadth, price, or future coverage decisions.

Ranks four through six · Large request-volume cohort

One of the ten largest authorization workloads

The 750,000 recorded requests place this contract in the highest-volume tier. Its request-volume rank is #4 of 37. Volume shows the denominator behind approvals and denials; it is not a measure of plan quality, membership, benefit breadth, price, or future coverage decisions.

Bottom-seven record · Lower overturn-rate cohort

One of the ten lowest appeal overturn rates

63.0% of filed appeals were overturned, placing this record in the lowest-rate tier. Its overturn-rate rank is #32 of 37. The denominator is filed appeals, not all authorization requests. The percentage therefore describes reviewed appeals and must not be read as an individual outcome forecast.

Bottom-seven record · Narrow reversal reach

Overturned appeals covered a small share of denials

9.4% of the plan's denials were ultimately overturned through the appeals counted here. The cross-contract rank is #32 of 37. This derived measure combines appeal filing and outcome, so it supplies scale context but does not identify clinical reasons, administrative errors, or coverage rules.

Ranks seven through ten · Higher denial-rate cohort

A top-ten denial rate in this source set

Anthem Elevance MA's 9.3% denial rate is in the highest group of the comparison. The exact rank is #10 of 37. This is aggregate prior-authorization activity for the reporting window, not a probability that a particular service, drug, or beneficiary request will be denied.

Ranks seven through ten · High appeal-filing share

Appeals followed a large share of denials

10,463 appeals equal 15.0% of this contract's recorded denials. That is rank #10 of 37 for filing share. The ratio reports aggregate activity; it cannot reveal why an appeal was or was not filed, whether the underlying cases were comparable, or what happened outside the reporting window.

Prior Authorization Scorecard

PA Requests
750,000
PA Denial Rate
9.3%
Appeals Filed
10,463
Appeal Overturn Rate
63.0%

Detailed Metrics

Metric Value
Prior Authorization Requests 750,000
PA Approved 680,250
PA Denied 69,750
Appeals Filed 10,463
Appeals Overturned 6,591
Source: CMS Office of Inspector General report OEI-09-22-00380; KFF 2023 Medicare Advantage analysis. Verify with HHS OIG → · CMS.gov →
Sources, caveats, and related notes for Anthem Elevance MA
What does Anthem Elevance MA's overturn rate mean? Of the appeals filed after denials in this source record, 63% were overturned (6,591 of 10,463 filed appeals, not all 69,750 denied requests).
This data is for informational purposes only and does not constitute medical, financial, or insurance advice. Contact CMS or your plan for coverage decisions. Data from CMS OIG and KFF Medicare Advantage analysis.

Data: CMS OIG OEI-09-22-00380 and KFF 2023 Medicare Advantage analysis. Not affiliated with CMS. ← All MA plans

Read our methodology - how this data is sourced, computed, and verified.

Primary data: U.S. Department of Health & Human Services, Office of Inspector General, Medicare Advantage Encounter Data (Report OEI-09-22-00380, 2024). Secondary data: Kaiser Family Foundation 2023 Medicare Advantage Prior Authorization analysis. Methodology and editorial review by PlainInsurer, see methodology.