Organization Detail
Banner Health Network
3 plans across 1 state · Medicare AdvantageMedicaid MCO
Banner Health Network reported prior authorization metrics for 3 Medicare Advantage, Medicaid MCO plans across 1 state under CMS rule CMS-0057-F for calendar year 2025. The average standard prior authorization denial rate was 13.5%, above the national average of 11.8%. When patients or providers appealed denied prior authorizations, 5.1% of appeals were overturned on average. Standard prior authorization decisions took an average of 2.7 days.
13.5%
Banner Health Network Denial Rate
standard, avg across 3 plans
11.8%
National Average
all reporting plans
+1.7%
vs. National
near average
AZ3 plans
| Plan | Requests | Approved | Denied | Appr % | Denial % ▼ | Appeals | Overturn % | Denied Appeal % | Appr Ext % | Denied Ext % | Mean Days | Med Days |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Banner University Family Care / ACCMedicaid MCO | — | — | — | 85.2% | 14.8% | — | 2.7% | 97.3% | 42.5% | 57.5% | 2.8 | 0.0 |
| Banner Medicare Advantage Prime HMOMedicare Advantage | — | — | — | 86.7% | 13.3% | — | 2.7% | 97.3% | 50.0% | 50.0% | 2.3 | 1.0 |
| Banner Medicare Advantage Dual HMO D-SNPMedicare Advantage | — | — | — | 87.5% | 12.5% | — | 10.0% | 90.0% | 0.0% | 100.0% | 2.9 | 1.0 |