Rise in MA Prior Authorization Denials: New Study Sheds Light


 A new study reveals considerable differences among Medicare Advantage (MA) plans in the volume of determinations and the frequency of denials. Notably, there was a surge in MA Prior Authorization Denials between 2021 and 2022, as highlighted by recent health policy research.

Researchers analyzed data from the Centers for Medicare & Medicaid Services, uncovering that 46 million prior authorization requests were submitted to MA insurers in 2022, averaging 1.7 requests per enrollee.

Increase in MA Prior Authorization Denials: 7.4% of Requests Rejected in 2022:

Of these requests, 3.4 million, or 7.4%, were denied, underscoring the growing issue of prior authorization denials in Medicare Advantage. This marks an increase from 5.8% in 2021, 5.6% in 2020, and 5.7% in 2019. Despite the rise in denial rates, the number of requests per enrollee in 2022 remained on par with 2019 levels.

The study also revealed significant disparities among Medicare Advantage plans in the number of determinations and denial rates. Humana, for example, saw the highest rate of prior authorization requests at 2.9 per enrollee, while Kaiser Permanente had the lowest at just 0.5 per enrollee. The analysis notes Kaiser’s distinct structure, which directly provides a wide range of services to its members.

For more information: https://www.allzonems.com/medicare-advantage-prior-authorization-denials-study/

Benefits of Partnering with Allzone:

  • Reduced Denials: Experience fewer denials and increased revenue.

  • Improved Patient Satisfaction: Faster approvals lead to better patient experiences.

  • Enhanced Efficiency: Streamlined processes save time and resources.

  • Data-Driven Insights: Our analytics provide valuable data to optimize your PA strategy.

Choose Allzone Management Services for:

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  • Personalized Solutions: Tailored strategies to meet your specific needs.

  • Proven Results: A track record of success in optimizing PA for healthcare providers.

Ready to take control of your medical billing process? Contact Allzone Management Services, the trusted medical billing company, today for a consultation.

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