Contract: H1542 · Plan type: HMO
Evidence lead: Ranks twenty-six through thirty · Lower-middle appeal uptake
Filed appeals account for 15.0% of this contract's denials, or 832 records. That is rank #29 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.
Ranks twenty-six through thirty · Lower-middle appeal uptake
Filed appeals account for 15.0% of this contract's denials, or 832 records. That is rank #29 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.
Ranks twenty-one through twenty-five · Moderate request-volume cohort
This contract's 76,000 requests form a moderate comparison base within the table. Its request-volume rank is #25 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 twenty-one through twenty-five · Lower-middle reversal reach
The 574 recorded reversals amount to 10.3% of this contract's denied requests. The cross-contract rank is #23 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 sixteen through twenty · Upper-middle denial cohort
The recorded 7.3% denial rate falls in the upper-middle portion of the contract set. The exact rank is #17 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 twenty-one through twenty-five · Lower-middle overturn cohort
This contract records a 69.0% overturn rate among filed appeals. Its overturn-rate rank is #21 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.
| Metric | Value |
|---|---|
| Prior Authorization Requests | 76,000 |
| PA Approved | 70,452 |
| PA Denied | 5,548 |
| Appeals Filed | 832 |
| Appeals Overturned | 574 |
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.