Evidence file · prior-authorization-humana-national-h5178-2025
Humana
H5178 · Medicare Advantage · 2025
The takeaway
What this record says—and what it does not
This Medicare Advantage reporting unit denied 8.3 of every 100 standard prior-authorization requests in 2025.
- Compared with what?
- That is above the 7.6% median among 74 records in this library with the same program, year, and metric. This is a directional comparison, not a quality grade.
- How could I use this?
- Use it to ask the payer about its review process, compare like reporting units, or identify a pattern worth deeper reporting, research, or regulatory review.
- What can’t I conclude?
- It is an aggregate rate. It does not identify a service, explain a particular decision, prove that a denial was wrongful, or describe a different plan or program.
- Standard requests
- 567 count
- Standard requests denied
- 8.29%
- Standard requests denied
- 47 count
- Appeals
- 0 count
- Appeals overturned
- Not reported
- Expedited requests
- 5 count
- Expedited requests denied
- 20%
Scope and limits
- Family
- prior-authorization
- Scope
- Contract-level CMS-0057-F prior authorization disclosure
- Status
- published
- Missing fields
- appeal overturn rate
Artifact and version
- Captured
- 2026-07-17T21:57:18.825Z
- SHA-256
- 45ac3dfb60e27107bb6afac54ffb8ef0f36e682bd7b160c4cd58917839e12cdd
- Version
- 45ac3dfb60e2
- Extraction
- Parsed from the checked source extraction and normalized by pipeline v1.
Citation and files
Humana H5178, CMS-0057-F prior authorization metrics, plan year 2025.
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