Prior Auth Intelligence Brief — PCP Edition

Prior Authorization Intelligence Brief — Primary Care Edition

As of March 31, 2026, CMS now requires Medicare Advantage plans, Marketplace plans, Medicaid, and CHIP managed care to publicly post their prior authorization denial rates, appeal overturn rates, and decision timelines every year. The data is live. Most practices don't know it exists or what to do with it.

This free brief closes that gap.

What's inside:

Denial rates by major payer (UnitedHealthcare, CVS/Aetna, Humana, Elevance, Cigna, Centene) sourced directly from KFF's 2024 Medicare Advantage analysis. The most common denied service categories in primary care. The most common denial reasons, and how to prevent them at the point of care. A 5-step Prior Authorization Workflow Framework your practice can apply today, no consultant required.

Who this is for:

Primary care physicians, practice managers, and medical billing staff who are tired of absorbing denials that should never have happened.

About the author:

Maria A. Mirt Sánchez, MD, MSc, CPC, CRC, CDEO, is the founder of MIRT MD Consulting, a physician-led healthcare operations consultancy specializing in CDI, HCC risk adjustment, Medicare Advantage compliance, prior authorization strategy, and revenue cycle management. With 18+ years of US healthcare experience spanning clinical practice, payer-side operations, and coding, she helps practices diagnose the root cause of revenue leakage and fix it.

Need a version built for your specific payer mix, specialty, and denial history? Book a free 30-minute consultation at mirtmdconsulting.com.