An analysis by KFF released Jan. 28 found that Medicare Advantage insurers made nearly 50 million prior authorization determinations in 2023. The finding reflects continued year-over-year increases from 2022 (42 million) and 2021 (37 million) as more people have enrolled in MA. KFF also found that in 2023 there was an average of nearly two prior authorization determinations per MA enrollee. 

The analysis found that insurers fully or partially denied 3.2 million prior authorization requests (6.4%) in 2023, a smaller share than 2022 (7.4%). In 2023, 11.7% of denied prior authorization requests were appealed in MA and of those cases, 81.7% were partially or fully overturned.

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The AHA provided comments to the Medicare Payment Advisory Commission Oct. 2 on a discussion from the commission’s September meeting on its examination of…
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The Centers for Medicare & Medicaid Services announced Sept. 28 that it projects declines in average premiums for Medicare Advantage and Part D in 2027.…
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The Workgroup for Electronic Data Interchange has launched its fall 2026 survey to assess industry readiness for the Centers for Medicare & Medicaid…
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This webinar explores how hospital and health system leaders can prepare for Medicare Advantage’s new electronic prior authorization mandate, which goes into…
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The U.S. District Court for the Eastern District of Pennsylvania Aug. 5 granted a motion for the AHA and the Hospital and Healthsystem Association of…
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An AHA blog published July 28 highlights new electronic prior authorization requirements that begin Jan. 1, 2027, as a result of the Centers for Medicare…