Payers with most MA prior authorization requests, denials

The report, published Feb. 2, analyzed data for 515 MA contracts in 2021, accounting for 87 percent of the program’s enrollees. 

Here’s how payers compared on prior authorization requests and denial rates:

Average number of prior authorization requests per member (2021) 

1. Elevance Health (Anthem): 2.9 per member

2. Humana: 2.8 per member

3. Centene: 2.6 per member

4. BCBS plans: 2.2 per member

5. Other plans: 1.7 per member

6. Cigna: 1.3 per member

7. CVS: 0.8 per member

8. UnitedHealthcare: 0.8 per member

9. Kaiser Permanente: 0.3 per member 

Prior authorization denial rates (2021) 

1. CVS: 12 percent (tie)

    Kaiser Permanente: 12 percent (tie)

3. Centene: 10 percent 

4. UnitedHealthcare: 9 percent 

5, Cigna: 8 percent 

6. BCBS plans: 6 percent 

7. Others: 5 percent 

8. Elevance Health (Anthem): 3 percent

9. Humana: 3 percent 

Read more here.

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