Organization Detail
Lumeris Group Holdings
2 plans across 1 state · Medicare Advantage
Lumeris Group Holdings reported prior authorization metrics for 2 Medicare Advantage plans across 1 state under CMS rule CMS-0057-F for calendar year 2025. Across those plans, Lumeris Group Holdings processed 14,334 standard prior authorization requests. The average standard prior authorization denial rate was 12.6%, above the national average of 11.8%. When patients or providers appealed denied prior authorizations, 7.2% of appeals were overturned on average. Standard prior authorization decisions took an average of 1 days.
12.6%
Lumeris Group Holdings Denial Rate
standard, avg across 2 plans
11.8%
National Average
all reporting plans
+0.8%
vs. National
near average
MO2 plans
| Plan | Requests | Approved | Denied | Appr % | Denial % ▼ | Appeals | Overturn % | Denied Appeal % | Appr Ext % | Denied Ext % | Mean Days | Med Days |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Essence Advantage HMO (H2610) - MissouriMedicare Advantage | 10,629 | 9,165 | 1,464 | 86.2% | 13.8% | — | 6.2% | 93.8% | 0.0% | 0.0% | 1.0 | 0.0 |
| Essence Advantage PPO (H6200) - MissouriMedicare Advantage | 3,705 | 3,281 | 424 | 88.6% | 11.4% | — | 8.3% | 91.8% | 0.0% | 0.0% | 1.0 | 1.0 |