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Medicare Advantage Prior Authorizations Up 7.8% In 2023

Medicare Advantage (MA) plan prior authorization use increased 7.8% to 49.8 million determinations from 2022 to 2023. MA insurers fully or partially denied 3.2 million (6.4%) prior authorization requests. Of the prior authorization denials, just 11.7% were appealed, with the most appealed denials being fully or partially overturned. However, 81.7% of these appeals were partially or fully overturned (compared to just 29% in 2022). Centene denied the highest share of prior authorization requests (13.6%), while Humana denied the fewest (3.5%).

Prior authorization in Medicare is a process where certain services, procedures, or . . .

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