Evidence file · prior-authorization-humana-national-h5970-2025
Humana
H5970 · Medicare Advantage · 2025
The takeaway
What this record says—and what it does not
This Medicare Advantage reporting unit denied 7.2 of every 100 standard prior-authorization requests in 2025.
- Compared with what?
- That is near 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
- 87,764 count
- Standard requests denied
- 7.22%
- Standard requests denied
- 6,334 count
- Appeals
- 211 count
- Appeals overturned
- 63.03%
- Expedited requests
- 2,566 count
- Expedited requests denied
- 11.73%
Scope and limits
- Family
- prior-authorization
- Scope
- Contract-level CMS-0057-F prior authorization disclosure
- Status
- published
- Missing fields
- None identified in normalized fields
Artifact and version
- Captured
- 2026-07-17T21:57:18.957Z
- SHA-256
- 59341fced77bfb0171abb3357c957334aea5cf72ea11fe629427ceecfcb8ceac
- Version
- 59341fced77b
- Extraction
- Parsed from the checked source extraction and normalized by pipeline v1.
Citation and files
Humana H5970, CMS-0057-F prior authorization metrics, plan year 2025.
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