AultCare MA

Contract: H8057 · Plan type: HMO

Evidence lead: Bottom-seven record · Low appeal-filing share

AultCare MA: Only a small share of denials entered appeal

239 appeals correspond to 15.0% of the plan's denied requests. That is rank #37 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.

Bottom-seven record · Low appeal-filing share

Only a small share of denials entered appeal

239 appeals correspond to 15.0% of the plan's denied requests. That is rank #37 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.

Bottom-seven record · Smaller request-volume cohort

One of the narrower authorization records

The source records 29,000 requests here, placing the contract in the smallest-volume tier. Its request-volume rank is #36 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 denial-rate cohort

One of the ten lowest denial rates

AultCare MA's 5.5% rate belongs to the lowest-denial tier in this table. The exact rank is #31 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 overturn-rate cohort

One of the ten highest appeal overturn rates

75.0% of this contract's filed appeals were overturned in the source record. Its overturn-rate rank is #10 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.

Ranks eleven through fifteen · Upper-middle reversal reach

Reversals covered an above-median share of denials

Overturned appeals represent 11.2% of all denials here, based on 179 reversals. The cross-contract rank is #11 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.

Prior Authorization Scorecard

PA Requests
29,000
PA Denial Rate
5.5%
Appeals Filed
239
Appeal Overturn Rate
75.0%

Detailed Metrics

Metric Value
Prior Authorization Requests 29,000
PA Approved 27,405
PA Denied 1,595
Appeals Filed 239
Appeals Overturned 179
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 AultCare MA
What does AultCare MA's overturn rate mean? Of the appeals filed after denials in this source record, 75% were overturned (179 of 239 filed appeals, not all 1,595 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.