Evidence file · prior-authorization-humana-national-r5361-2025
Humana
R5361 · Medicare Advantage · 2025
The takeaway
What this record says—and what it does not
This Medicare Advantage reporting unit denied 6.5 of every 100 standard prior-authorization requests in 2025.
- Compared with what?
- That is below 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
- 5,148 count
- Standard requests denied
- 6.51%
- Standard requests denied
- 335 count
- Appeals
- 9 count
- Appeals overturned
- 66.67%
- Expedited requests
- 81 count
- Expedited requests denied
- 6.17%
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
- 2026-07-17T21:57:19.095Z
- SHA-256
- 2103b6c5b8523d39a622639fd8a7202739d1826ab535304d18fa4cd55b309932
- Version
- 2103b6c5b852
- Extraction
- Parsed from the checked source extraction and normalized by pipeline v1.
Citation and files
Humana R5361, CMS-0057-F prior authorization metrics, plan year 2025.
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