Organization Detail
Highmark
8 plans across 4 states · Medicare AdvantageMedicaid FFSExchange PlansMedicaid MCO
6.5%
Highmark Denial Rate
standard, avg across 8 plans
12.7%
National Average
all reporting plans
-6.2%
vs. National
below average
DE2 plans
| Plan | Requests | Approved | Denied | Appr % | Denial % ▼ | Appeals | Overturn % | Denied Appeal % | Appr Ext % | Denied Ext % | Mean Days | Med Days | Source |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Highmark DE DSNP Medicare Advantage (H7710)Medicare Advantage | 671 | 588 | 83 | 88.0% | 12.0% | — | — | — | 100.0% | 0.0% | 4.8 | 5.0 | View source ↗ |
| Delaware Medicaid/CHIP FFS (via Highmark)Medicaid FFS | 32,291 | 31,809 | 482 | 99.0% | 1.0% | 156 | 24.0% | 76.0% | 90.0% | 10.0% | 3.8 | 4.0 | View source ↗ |
NY1 plan
| Plan | Requests | Approved | Denied | Appr % | Denial % ▼ | Appeals | Overturn % | Denied Appeal % | Appr Ext % | Denied Ext % | Mean Days | Med Days | Source |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| New York Medicaid/CHIP FFS (via Highmark)Medicaid FFS | — | — | — | 91.3% | 8.7% | — | 39.9% | 60.1% | — | — | 2.0 | 2.0 | View source ↗ |
PA3 plans
| Plan | Requests | Approved | Denied | Appr % | Denial % ▼ | Appeals | Overturn % | Denied Appeal % | Appr Ext % | Denied Ext % | Mean Days | Med Days | Source |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Highmark PA DSNP Medicare Advantage (H5932)Medicare Advantage | 7,010 | 6,152 | 857 | 88.0% | 12.0% | 440 | 72.0% | 28.0% | 100.0% | 0.0% | 4.7 | 5.5 | View source ↗ |
| Highmark QHP (FFE)Exchange Plans | 120,652 | 111,548 | 9,104 | 92.0% | 8.0% | 43 | 47.0% | 53.0% | 98.0% | 2.0% | 0.5 | 0.5 | View source ↗ |
| Pennsylvania Medicaid/CHIP FFS (via Highmark)Medicaid FFS | 22,141 | 21,291 | 850 | 96.0% | 4.0% | 1,744 | 35.0% | 65.0% | 90.0% | 10.0% | 1.5 | 0.5 | View source ↗ |
WV2 plans
| Plan | Requests | Approved | Denied | Appr % | Denial % ▼ | Appeals | Overturn % | Denied Appeal % | Appr Ext % | Denied Ext % | Mean Days | Med Days | Source |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| West Virginia Medicaid FFS (via Highmark)Medicaid FFS | 1,426 | 1,371 | 55 | 96.0% | 4.0% | 3 | 0.0% | 100.0% | 97.0% | 80.0% | 0.5 | 0.5 | View source ↗ |
| Highmark Health Options WV (Medicaid)Medicaid MCO | — | — | — | 98.0% | 2.0% | — | 34.0% | 66.0% | 90.0% | 10.0% | 2.1 | 2.0 | View source ↗ |