Think this is getting added to the TriZetto algorithm? 😂
Centene denied 15% of standard Medicare Advantage prior auth requests in 2025.
Then 93% of the denials that were appealed got overturned.
But it was “one person at a time.” 😬
Centene also had the highest ACA denial rate listed at 25%.
Hard not to look at numbers like that and wonder whether the system is designed to get the right answer the first time, or just make people fight hard enough to get there.
Maybe the next efficiency initiative is getting rid of the members who keep appealing. 🤡
https://www.beckershospitalreview.com/finance/payers-ranked-by-prior-authorization-denial-rates/