Payers with most MA prior authorization requests, denials

Elevance Health has the highest number of prior authorization requests per Medicare Advantage member, while CVS and Kaiser Permanente have the highest rate of denials in 2021, according to an analysis from Kaiser Family Foundation. 

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.


Copyright © 2024 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.

 

Top 40 articles from the past 6 months