Project Crossfoot
02 · Explorer

Prior authorization denial rates, plan by plan

Every plan that published a CY2025 filing. Search for an insurer or a plan by name, narrow by state or market, and the charts and the weighted rate below recompute as you go.

Reset
658 of 658
filings in view
67.4M
standard requests
11.0%
volume-weighted denial rate
77
with validation findings

The weighted rate is computed over filings in view that published both a request total and a denial count; the request figure beside it counts every filing in view.

Distribution of denial rates
filings per 10-point band · click a bar for its filings
295
250
89
8
9
2
0–10%
10–20%
20–30%
30–40%
40–50%
50–65%
Denial rate vs. request volume
log volume, 1K → 500K · orange marks carry findings · click a point for the filing
1K10K100K500K
Request volume by market, current filter
Medicare Advantage 27.5M 286 filings
Medicaid Managed Care 25.0M 224 filings
Medicaid FFS 8.9M 22 filings
Marketplace QHP 4.9M 70 filings
Medicare-Medicaid Plan 419K 14 filings
Unclassified 387K 11 filings
Multiple (combined) 208K 3 filings
CHIP Managed Care 120K 28 filings
Where the denial rate is highest
volume-weighted per state · floor 10K requests · top 10 · click a state for its filings
MN 33.0% 99K · 12 filings
AL 28.5% 39K · 1 filing
CO 21.5% 1.9M · 12 filings
SC 21.3% 241K · 4 filings
MI 20.1% 771K · 12 filings
MO 19.6% 307K · 4 filings
AR 19.1% 27K · 1 filing
OK 19.0% 271K · 5 filings
DE 18.4% 141K · 8 filings
VA 18.2% 1.7M · 10 filings
Organizations by denials in view
standard denials summed over the slice · weighted rate beside each · top 10
UnitedHealth Group 1.3M 12.8%
California DHCS 1.1M 28.9%
Centene 1.1M 12.2%
Humana 733K 6.8%
Colorado HCPF 390K 22.3%
Wellcare 325K 16.2%
Ohio Department of Medicaid 241K 17.3%
Healthfirst 240K 13.6%
AmeriHealth Caritas 193K 23.4%
Virginia DMAS 177K 24.4%
Rate spread by market
the box is the middle half of the market's rates, the whisker runs 10th–90th percentile, the median is marked · orange dots are the filings past the 90th · click a box for the market, a dot for the filing
0%10%20%30%40%50%60%Medicare Advantage286 filingsMedicare Advantage: median 9.3%, middle half 6.0–14.8%, 90th percentile 19.5%9.3UCare · UCare Connect + Medicare — 46.6%UCare · UCare Minnesota Senior Health Options (MSHO) — 43.9%Univera Healthcare · Univera Healthcare Medicare D-SNP (HMO) — 36.4%UCare · EssentiaCare Plans — 35.1%Excellus BlueCross BlueShield · Excellus BCBS Medicare D-SNP (HMO) — 29.3%UCare · UCare Medicare Plans — 28.9%UnitedHealth Group · UnitedHealthcare Medicare Advantage - Contract R7444 — 27.8%Hamaspik · Hamaspik Medicare Select (H0034 D-SNP & MAP Medicare, combined) — 26.0%UnitedHealth Group · UnitedHealthcare Medicare Advantage - Contract H1537 — 25.2%UnitedHealth Group · UnitedHealthcare Medicare Advantage - Contract H2001 — 23.5%UCare · UCare Your Choice Plans — 22.9%UnitedHealth Group · UnitedHealthcare Medicare Advantage - Contract H0710 — 22.3%UnitedHealth Group · UnitedHealthcare Medicare Advantage - Contract R5342 — 22.1%UnitedHealth Group · UnitedHealthcare Medicare Advantage - Contract H5435 — 22.0%UnitedHealth Group · UnitedHealthcare Medicare Advantage - Contract H3307 — 21.6%UnitedHealth Group · UnitedHealthcare Medicare Advantage - Contract H3379 — 21.4%UnitedHealth Group · UnitedHealthcare Medicare Advantage - Contract R0759 — 21.2%UnitedHealth Group · UnitedHealthcare Medicare Advantage - Contract H3418 — 21.1%UnitedHealth Group · UnitedHealthcare Medicare Advantage - Contract H0755 — 20.9%UnitedHealth Group · UnitedHealthcare Medicare Advantage - Contract H8211 — 20.9%Wellcare · Wellcare — 20.8%UnitedHealth Group · UnitedHealthcare Medicare Advantage - Contract H1659 — 20.7%UnitedHealth Group · UnitedHealthcare Medicare Advantage - Contract R2604 — 20.6%UnitedHealth Group · UnitedHealthcare Medicare Advantage - Contract H2802 — 20.6%UnitedHealth Group · UnitedHealthcare Medicare Advantage - Contract H8768 — 20.6%Wellcare · Wellcare — 20.4%UnitedHealth Group · UnitedHealthcare Medicare Advantage - Contract H0294 — 19.8%Wellcare · Wellcare — 19.6%Wellcare · Wellcare — 19.5%Medicaid Managed Care220 filingsMedicaid Managed Care: median 12.7%, middle half 7.2–17.6%, 90th percentile 23.1%12.7VillageCare · VillageCareMAX Managed Long-Term Care — 62.3%Hamaspik · Hamaspik Medicare Choice (MAP - Medicaid side) — 52.0%Hamaspik · Hamaspik Choice (MLTC) — 49.0%UCare · Prepaid Medical Assistance Program (PMAP) — 47.8%UCare · UCare Connect — 45.2%UCare · MinnesotaCare (MnCare) — 45.1%UCare · Minnesota Senior Care Plus (MSC+) — 41.9%Blue Cross Blue Shield of Michigan · Blue Cross Complete of Michigan — 34.9%Centene · Oklahoma Complete Health - SoonerSelect — 32.4%VillageCare · VillageCareMAX Total Advantage (D-SNP) - Medicaid requests — 28.6%AmeriHealth Caritas · Keystone First — 28.4%AmeriHealth Caritas Family of Companies · AmeriHealth Caritas Delaware (Medicaid) — 28.3%Independent Health · Independent Health Medicaid, Essential and CHP (combined) — 28.2%Elevance Health · Healthy Blue South Carolina (BlueChoice HealthPlan of South Carolina) — 27.9%CVS Health / Aetna · Aetna Better Health of New Jersey — 27.6%Molina Healthcare · Molina Healthcare of South Carolina Medicaid — 27.0%AmeriHealth Caritas · AmeriHealth Caritas Pennsylvania — 25.5%Priority Health · Priority Health Choice (Medicaid) — 25.2%Centene · MHS Indiana - Hoosier Care Connect — 25.2%Centene · Buckeye Health Plan (Ohio Medicaid) — 24.7%Centene · Arizona Complete Health - Complete Care — 23.3%CVS Health / Aetna · Aetna Better Health of Maryland — 23.2%Marketplace QHP69 filingsMarketplace QHP: median 16.8%, middle half 9.0–22.7%, 90th percentile 27.0%16.8Centene · Ambetter from Superior HealthPlan (29418) — 32.9%Centene · Ambetter from Superior HealthPlan (87226) — 32.5%Centene · Ambetter of Oklahoma — 30.1%Centene · Ambetter of Alabama — 28.5%Centene · Ambetter from Buckeye Health Plan — 28.4%Centene · Ambetter Health of Delaware — 27.7%CHIP Managed Care28 filingsCHIP Managed Care: median 11.6%, middle half 6.5–17.0%, 90th percentile 19.9%11.6AmeriHealth Caritas Family of Companies · AmeriHealth Caritas Delaware CHIP — 48.4%Healthfirst · Child Health Plus — 28.3%UnitedHealth Group · New York Child Health Plus — 26.5%Medicaid FFS22 filingsMedicaid FFS: median 8.3%, middle half 2.8–17.1%, 90th percentile 26.5%8.3California DHCS · Medi-Cal Dental Fee-for-Service — 29.5%California DHCS · Medi-Cal Fee-for-Service (medical and behavioral health) — 28.4%California Department of Health Care Services · Medi-Cal and CHIP (fee-for-service) — 28.4%Medicare-Medicaid Plan14 filingsMedicare-Medicaid Plan: median 7.0%, middle half 5.9–9.2%, 90th percentile 22.4%7.0UnitedHealth Group · Texas MMP — 40.4%UnitedHealth Group · Massachusetts Senior Care Options — 33.3%Unclassified11 filingsUnclassified: median 18.2%, middle half 16.5–24.2%, 90th percentile 24.7%18.2Managed Health Services · Managed Health Services — 25.7%Multiple (combined)3 filingsTexas Children's Health Plan · Texas Children's Health Plan (STAR/CHIP/STAR Kids combined) — 9.9%HealthPartners · HealthPartners Medicare Advantage and Minnesota Senior Health Options (MSHO), combined — 6.3%Blue Cross & Blue Shield of Rhode Island · Blue Cross & Blue Shield of Rhode Island (all impacted lines combined) — 4.9%
How concentrated the denials are
plans ranked by denials, cumulative share · the dashed diagonal is every plan equal
25%50%75%100%0%25%50%75%100%top 10% of plans → 68.6% of denials10% of plans → 69% of denialsplans, ranked by denials →share of all denials ↑
What the slice actually discloses
how much of the current view can be checked — a rate without counts is a claim, not a number
■ 533 publish counts ▨ 125 publish no counts — a rate nobody can check ● 77 carry validation findings

Filings

This view as JSON
Sort
Denial rate Volume Organization Findings
Organization
Plan
Market
St
Std reqs
Denial rate
Findings
VillageCare VillageCareMAX Managed Long-Term Care Medicaid Managed Care NY — 62.3% 1 Hamaspik Hamaspik Medicare Choice (MAP - Medicaid side) Medicaid Managed Care NY — 52.0% 1 Hamaspik Hamaspik Choice (MLTC) Medicaid Managed Care NY — 49.0% 1 AmeriHealth Caritas Family of Companies AmeriHealth Caritas Delaware CHIP CHIP Managed Care DE 3K 48.4% 1 UCare Prepaid Medical Assistance Program (PMAP) Medicaid Managed Care MN 31K 47.8% 1 UCare UCare Connect + Medicare Medicare Advantage MN 4K 46.6% 1 UCare UCare Connect Medicaid Managed Care MN 7K 45.2% 1 UCare MinnesotaCare (MnCare) Medicaid Managed Care MN 6K 45.1% 1 UCare UCare Minnesota Senior Health Options (MSHO) Medicare Advantage MN 4K 43.9% 1 UCare Minnesota Senior Care Plus (MSC+) Medicaid Managed Care MN 1K 41.9% 1 UnitedHealth Group Texas MMP Medicare-Medicaid Plan TX 240 40.4% 1 Univera Healthcare Univera Healthcare Medicare D-SNP (HMO) Medicare Advantage NY 118 36.4% — UCare EssentiaCare Plans Medicare Advantage MN 382 35.1% — Blue Cross Blue Shield of Michigan Blue Cross Complete of Michigan Medicaid Managed Care MI 243K 34.9% — UnitedHealth Group Massachusetts Senior Care Options Medicare-Medicaid Plan MA 84 33.3% — Centene Ambetter from Superior HealthPlan (29418) Marketplace QHP TX 218K 32.9% 1 Centene Ambetter from Superior HealthPlan (87226) Marketplace QHP TX 90K 32.5% 1 Centene Oklahoma Complete Health - SoonerSelect Medicaid Managed Care OK 73K 32.4% — Centene Ambetter of Oklahoma Marketplace QHP OK 38K 30.1% — California DHCS Medi-Cal Dental Fee-for-Service Medicaid FFS CA 3.1M 29.5% — Excellus BlueCross BlueShield Excellus BCBS Medicare D-SNP (HMO) Medicare Advantage NY 2K 29.3% — UCare UCare Medicare Plans Medicare Advantage MN 18K 28.9% — VillageCare VillageCareMAX Total Advantage (D-SNP) - Medicaid requests Medicaid Managed Care NY — 28.6% — Centene Ambetter of Alabama Marketplace QHP AL 39K 28.5% — AmeriHealth Caritas Keystone First Medicaid Managed Care PA 315K 28.4% 1 Centene Ambetter from Buckeye Health Plan Marketplace QHP OH 53K 28.4% — California DHCS Medi-Cal Fee-for-Service (medical and behavioral health) Medicaid FFS CA 79K 28.4% 1 California Department of Health Care Services Medi-Cal and CHIP (fee-for-service) Medicaid FFS CA 79K 28.4% 1 AmeriHealth Caritas Family of Companies AmeriHealth Caritas Delaware (Medicaid) Medicaid Managed Care DE 71K 28.3% — Healthfirst Child Health Plus CHIP Managed Care NY 28K 28.3% — Independent Health Independent Health Medicaid, Essential and CHP (combined) Medicaid Managed Care NY 36K 28.2% — Elevance Health Healthy Blue South Carolina (BlueChoice HealthPlan of South Carolina) Medicaid Managed Care SC 55K 27.9% — UnitedHealth Group UnitedHealthcare Medicare Advantage - Contract R7444 Medicare Advantage — 18 27.8% — Centene Ambetter Health of Delaware Marketplace QHP DE 3K 27.7% — CVS Health / Aetna Aetna Better Health of New Jersey Medicaid Managed Care NJ 56K 27.6% — Cigna Cigna Individual & Family Plans (FFE) Marketplace QHP — — 27.0% — Cigna Healthcare Cigna Individual and Family Plans (FFE marketplace, all states combined) Marketplace QHP — — 27.0% — Molina Healthcare Molina Healthcare of South Carolina Medicaid Medicaid Managed Care SC — 27.0% — California DHCS California Children's Services (CCS) Medicaid FFS CA 756K 26.5% — UnitedHealth Group New York Child Health Plus CHIP Managed Care NY 2K 26.5% 1 Hamaspik Hamaspik Medicare Select (H0034 D-SNP & MAP Medicare, combined) Medicare Advantage NY — 26.0% — Centene Ambetter from Arizona Complete Health (91450) Marketplace QHP AZ 54K 26.0% — Managed Health Services Managed Health Services Unclassified — 79K 25.7% — Centene Ambetter from Sunflower Health Plan (34368) Marketplace QHP KS 64K 25.5% — AmeriHealth Caritas AmeriHealth Caritas Pennsylvania Medicaid Managed Care PA 279K 25.5% — Priority Health Priority Health Choice (Medicaid) Medicaid Managed Care MI 79K 25.2% — Centene MHS Indiana - Hoosier Care Connect Medicaid Managed Care IN 28K 25.2% — UnitedHealth Group UnitedHealthcare Medicare Advantage - Contract H1537 Medicare Advantage — 18K 25.2% — SilverSummit Healthplan SilverSummit Healthplan Unclassified — 32K 24.7% — Centene Buckeye Health Plan (Ohio Medicaid) Medicaid Managed Care OH 146K 24.7% — Centene Ambetter Health (Indiana / MHS Indiana marketplace) Marketplace QHP IN 57K 24.6% — Virginia DMAS Virginia Medicaid Fee-for-Service (Cardinal Care FFS) Medicaid FFS VA 724K 24.4% — Centene Ambetter from Louisiana Healthcare Connections Marketplace QHP LA 23K 24.3% — Sanford Health Sanford Health Plan QHP - Minnesota Marketplace QHP MN 33 24.2% — Sanford Health Plan Sanford Health Plan Unclassified — 33 24.2% — Nebraska Total Care Nebraska Total Care Unclassified — 53K 24.2% — UnitedHealth Group UnitedHealthcare Medicare Advantage - Contract H2001 Medicare Advantage — 1.9M 23.5% — Centene Arizona Complete Health - Complete Care Medicaid Managed Care AZ 164K 23.3% — CVS Health / Aetna Aetna Better Health of Maryland Medicaid Managed Care MD 16K 23.2% — Centene Ambetter from NH Healthy Families Marketplace QHP NH 16K 23.1% — Elevance Health Anthem BCBS Ohio Medicaid Medicaid Managed Care OH 132K 23.1% — Centene Oklahoma Complete Health - Children's Specialty Program Medicaid Managed Care OK 9K 23.0% — UCare UCare Your Choice Plans Medicare Advantage MN 4K 22.9% — Centene Ambetter from Home State Health (99723) Marketplace QHP MO 90K 22.8% — Centene Ambetter of Tennessee Marketplace QHP TN 105K 22.8% — Oscar Health Oscar Health - Texas Marketplace QHP TX — 22.7% — Centene Ambetter from Meridian Marketplace QHP MI 42K 22.7% — Centene Meridian Illinois Medicaid Medicaid Managed Care IL 316K 22.6% — Centene Louisiana Healthcare Connections Medicaid Managed Care LA 154K 22.6% — Centene Ambetter Health (Nebraska Total Care marketplace) Marketplace QHP NE 37K 22.5% — EmblemHealth EmblemHealth Medicaid and HARP (combined) Medicaid Managed Care NY 115K 22.5% — UnitedHealth Group Massachusetts One Care Medicare-Medicaid Plan MA 20K 22.4% — UnitedHealth Group New York Medicaid Advantage Medicaid Managed Care NY 76K 22.4% — Sanford Health Sanford Health Plan QHP - North Dakota Marketplace QHP ND 4K 22.4% — Sanford Health Plan Sanford Health Plan Unclassified — 4K 22.4% 1 CVS Health / Aetna Aetna Better Health of Florida Medicaid Managed Care FL 43K 22.4% — Colorado HCPF Health First Colorado / CHP+ (13 PA programs combined) Medicaid FFS CO 1.7M 22.3% — UnitedHealth Group UnitedHealthcare Medicare Advantage - Contract H0710 Medicare Advantage — 3K 22.3% — UnitedHealth Group Arizona AHCCCS Complete Care Medicaid Managed Care AZ 95K 22.2% — CVS Health / Aetna Aetna Better Health of Michigan Medicaid Managed Care MI 18K 22.1% — UnitedHealth Group UnitedHealthcare Medicare Advantage - Contract R5342 Medicare Advantage — 8K 22.1% — LINE OF BUSINESS: MARKETPLACE 27248 LINE OF BUSINESS: MARKETPLACE 27248 Marketplace QHP — 17K 22.0% — UnitedHealth Group UnitedHealthcare Medicare Advantage - Contract H5435 Medicare Advantage — 82 22.0% — AmeriHealth Caritas AmeriHealth Caritas Ohio Medicaid Managed Care OH 52K 21.9% — UnitedHealth Group UnitedHealthcare Medicare Advantage - Contract H3307 Medicare Advantage — 647 21.6% — Centene Ambetter from Magnolia Health (90714) Marketplace QHP MS 92K 21.5% — Centene Ambetter from Absolute Total Care (79222) Marketplace QHP SC 99K 21.5% — UnitedHealth Group UnitedHealthcare Medicare Advantage - Contract H3379 Medicare Advantage — 67K 21.4% — Centene Coordinated Care (Apple Health) Medicaid Managed Care WA 55K 21.3% — UnitedHealth Group UnitedHealthcare Medicare Advantage - Contract R0759 Medicare Advantage — 14K 21.2% — UnitedHealth Group UnitedHealthcare Medicare Advantage - Contract H3418 Medicare Advantage — 35K 21.1% — Centene Ambetter Health Florida / Celtic (49004) Marketplace QHP FL 419K 21.0% — Centene Meridian Michigan Medicaid Medicaid Managed Care MI 122K 21.0% — Centene Home State Health (MO HealthNet) Medicaid Managed Care MO 130K 21.0% — UnitedHealth Group UnitedHealthcare Medicare Advantage - Contract H0755 Medicare Advantage — 38K 20.9% — UnitedHealth Group UnitedHealthcare Medicare Advantage - Contract H8211 Medicare Advantage — 13K 20.9% — Wellcare Wellcare Medicare Advantage — 91K 20.8% — UnitedHealth Group UnitedHealthcare Medicare Advantage - Contract H1659 Medicare Advantage — 810 20.7% — Centene MHS Indiana - Hoosier Healthwise Medicaid Managed Care IN 35K 20.7% — Centene Ambetter of North Carolina (77264) Marketplace QHP NC 50K 20.7% — UnitedHealth Group UnitedHealthcare Medicare Advantage - Contract R2604 Medicare Advantage — 11K 20.6% — UnitedHealth Group UnitedHealthcare Medicare Advantage - Contract H2802 Medicare Advantage — 204K 20.6% — UnitedHealth Group UnitedHealthcare Medicare Advantage - Contract H8768 Medicare Advantage — 311K 20.6% — Oscar Health Oscar Health - Michigan Marketplace QHP MI — 20.5% — Kaiser Permanente Kaiser Foundation Health Plan of the Northwest - Oregon Medicaid Medicaid Managed Care OR 13K 20.4% — Wellcare Wellcare Medicare Advantage — 9K 20.4% — CareSource CareSource Ohio Medicaid Medicaid Managed Care OH 603K 20.0% — Elevance Health Wellpoint Maryland Medicaid Managed Care MD — 20.0% — Sentara Health Sentara Health Plans - Medicaid (Cardinal Care) Medicaid Managed Care VA 229K 20.0% — AmeriHealth Caritas Family of Companies Keystone First CHIP CHIP Managed Care PA 4K 19.9% — UnitedHealth Group UnitedHealthcare Medicare Advantage - Contract H0294 Medicare Advantage — 91K 19.8% — MetroPlus Health Plan MetroPlus Managed Long Term Care Medicaid Managed Care NY 4K 19.8% — UnitedHealth Group Pennsylvania Medicaid Medicaid Managed Care PA 28K 19.8% — Healthfirst Medicaid Managed Care Medicaid Managed Care NY 751K 19.7% — Wellcare Wellcare Medicare Advantage — 86K 19.6% — Wellcare Wellcare Medicare Advantage — 171K 19.5% — Kaiser Permanente Kaiser Permanente Southern California Medicare Advantage CA 144K 19.5% — CVS Health / Aetna Aetna Better Health of Kentucky Medicaid Managed Care KY 123K 19.5% — Wellcare Wellcare Medicare Advantage — 192K 19.3% — CVS Health / Aetna Aetna Better Health of West Virginia Medicaid Managed Care WV 83K 19.3% — Centene Wellcare by Superior HealthPlan H7323 Medicare Advantage TX 14K 19.2% — Wellcare Wellcare Medicare Advantage — 14K 19.2% — Centene Arkansas Total Care (PASSE) Medicaid Managed Care AR 27K 19.1% — AmeriHealth Caritas Family of Companies AmeriHealth Caritas District of Columbia Medicaid Managed Care DC 99K 19.1% — MetroPlus Health Plan MetroPlus HARP Medicaid Managed Care NY 6K 19.0% — CareSource CareSource Georgia (Georgia Families) Medicaid Managed Care GA — 19.0% — Ohio Department of Medicaid Ohio Medicaid Managed Care - all plans combined Medicaid Managed Care OH 1.2M 19.0% — UnitedHealth Group UnitedHealthcare Medicare Advantage - Contract H5253 Medicare Advantage — 643K 18.9% — Oscar Health Oscar Health - Arizona Marketplace QHP AZ — 18.9% — Wellcare Wellcare Medicare Advantage — 41K 18.8% — AmeriHealth Caritas Family of Companies AmeriHealth Caritas New Hampshire Medicaid Managed Care NH 17K 18.8% 2 Centene Wellcare Medicare Advantage H2117 Medicare Advantage MI 18K 18.8% — Wellcare Wellcare Medicare Advantage — 18K 18.8% — UnitedHealth Group UnitedHealthcare Medicare Advantage - Contract R3444 Medicare Advantage — 3K 18.6% — Oscar Health Oscar Health - Oklahoma Marketplace QHP OK — 18.5% — Wellcare Wellcare Medicare Advantage — 27K 18.5% — Oscar Health Oscar Health - Ohio (issuer 45845) Marketplace QHP OH — 18.4% — Centene Sunshine Health Medicaid MMA Medicaid Managed Care FL 418K 18.3% — Centene Ambetter Health Florida (86382) Marketplace QHP FL 6K 18.3% — AmeriHealth Caritas Family of Companies First Choice by Select Health of South Carolina Medicaid Managed Care SC 72K 18.3% 1 Magnolia Health Plan Magnolia Health Plan Unclassified — 105K 18.2% — CDPHP CDPHP Child Health Plus CHIP Managed Care NY 455 18.0% — Driscoll Health Plan Driscoll Health Plan STAR Kids Medicaid Managed Care TX — 18.0% — CVS Health / Aetna Aetna Better Health Kids (Pennsylvania CHIP) CHIP Managed Care PA 2K 18.0% 2 EmblemHealth EmblemHealth Child Health Plus CHIP Managed Care NY 6K 17.9% — UnitedHealth Group UnitedHealthcare Medicare Advantage - Contract H1045 Medicare Advantage — 182K 17.9% — VillageCare VillageCareMAX Medicare (all plans, aggregated) Medicare Advantage NY — 17.8% — Absolute Total Care Absolute Total Care Unclassified — 57K 17.7% — Horizon Blue Cross Blue Shield of New Jersey Horizon NJ FamilyCare (Medicaid) Medicaid Managed Care NJ — 17.7% — Oscar Health Oscar Health - Iowa Marketplace QHP IA — 17.6% — Elevance Health Wellpoint West Virginia Medicaid Managed Care WV — 17.6% — Priority Health Priority Health Qualified Health Plan Marketplace QHP MI 37K 17.6% — Blue Cross and Blue Shield of North Carolina Blue Cross NC ACA (Marketplace) plans Marketplace QHP NC — 17.5% — Wellcare Wellcare Medicare Advantage — 43K 17.5% — Network Health (Wisconsin) Network Health MSA Network Prime Medicare Advantage WI 790 17.5% — UnitedHealth Group UnitedHealthcare Medicare Advantage - Contract H2406 Medicare Advantage — 416K 17.3% — Centene Wellcare Medicare Advantage H0351 Medicare Advantage AZ 33K 17.3% — AmeriHealth Caritas Family of Companies AmeriHealth Caritas VIP Care (Pennsylvania) Medicare Advantage PA 25K 17.2% — CVS Health / Aetna Aetna Better Health of Virginia Medicaid Managed Care VA 108K 17.2% — Ohio Department of Medicaid Ohio Medicaid Fee-for-Service Medicaid FFS OH 31K 17.1% — The Health Plan The Health Plan - West Virginia Medicaid Medicaid Managed Care WV 49K 17.1% — UnitedHealth Group UnitedHealthcare Medicare Advantage - Contract H1889 Medicare Advantage — 178K 17.1% — Centene Wellcare Medicare Advantage H5590 Medicare Advantage AZ 44K 17.1% — Oscar Health Oscar Health - North Carolina Marketplace QHP NC — 17.1% — Driscoll Health Plan Driscoll Health Plan STAR Medicaid Managed Care TX — 17.0% — Molina Healthcare Molina Healthcare of Texas CHIP Medicaid CHIP Managed Care TX — 17.0% — Molina Healthcare Molina Healthcare of Texas STAR Medicaid Managed Care TX — 17.0% — Wellcare Wellcare Medicare Advantage — 3K 16.9% — Centene Peach State Health Plan Medicaid Medicaid Managed Care GA 215K 16.9% — MHS Health Wisconsin MHS Health Wisconsin Unclassified — 14K 16.8% — Umpqua Health Umpqua Health Alliance Medicaid Managed Care OR — 16.8% — Oscar Health Oscar Health - Nebraska Marketplace QHP NE — 16.8% — UnitedHealth Group New York Essential Plan Program Medicaid Managed Care NY 19K 16.7% — Wellcare Wellcare Medicare Advantage — 15K 16.6% — Community Health Choice Community Health Choice CHIP & CHIP Perinatal (combined) CHIP Managed Care TX 3K 16.6% 1 Oscar Health Oscar Health - Ohio (issuer 29341) Marketplace QHP OH — 16.6% — Sanford Health Sanford Health Plan QHP - South Dakota Marketplace QHP SD 3K 16.5% — Sanford Health Plan Sanford Health Plan Unclassified — 3K 16.5% 1 Wellcare Wellcare Medicare Advantage — 26K 16.5% — Wellcare Wellcare Medicare Advantage — 151K 16.5% — Wellcare Wellcare Medicare Advantage — 151K 16.5% — Centene Pennsylvania Health & Wellness (Community HealthChoices) Medicaid Managed Care PA 20K 16.5% — AmeriHealth Caritas Family of Companies AmeriHealth Caritas VIP Care (Michigan) Medicare Advantage MI 6K 16.4% 1 CVS Health / Aetna Aetna Medicare Advantage - contract H5309 Medicare Advantage — — 16.3% — Wellcare Wellcare Medicare Advantage — 107K 16.2% — Wellcare Wellcare Medicare Advantage — 107K 16.2% — Wellcare Wellcare Medicare Advantage — 107K 16.2% — Wellcare Wellcare Medicare Advantage — 107K 16.2% — Wellcare Wellcare Medicare Advantage — 107K 16.2% — Oscar Health Oscar Health - Missouri Marketplace QHP MO — 16.1% — Johns Hopkins Medicine Johns Hopkins Advantage MD (HMO) - Contract H1225 Medicare Advantage MD 13K 16.1% — UnitedHealth Group Texas STAR Medicaid Managed Care TX 139K 16.0% — Molina Healthcare Molina Healthcare of New York Medicaid Medicaid Managed Care NY — 16.0% — Molina Healthcare Molina Healthcare of Washington (Apple Health) Medicaid Managed Care WA 140K 16.0% — UnitedHealth Group Maryland HealthChoice Medicaid Managed Care MD 44K 16.0% 1 UnitedHealth Group UnitedHealthcare Medicare Advantage - Contract H6595 Medicare Advantage — 11K 16.0% — Univera Healthcare Univera Healthcare MyHealth (MMC) Medicaid Managed Care NY 5K 16.0% — Point32Health Harvard Pilgrim Health Care – New Hampshire Exchange Local Choice Marketplace QHP NH 182 15.9% 1 Centene Wellcare Medicare Advantage H6550 Medicare Advantage KS 6K 15.9% — Wellcare Wellcare Medicare Advantage — 850 15.9% — UnitedHealth Group UnitedHealthcare Medicare Advantage - Contract H0432 Medicare Advantage — 40K 15.7% — MetroPlus Health Plan MetroPlus Partnership in Care (HIV SNP) Medicaid Managed Care NY 2K 15.7% — Wellcare Wellcare Medicare Advantage — 13K 15.7% — CVS Health / Aetna Aetna Better Health of Illinois Medicaid Managed Care IL 111K 15.6% — Point32Health Tufts Health RITogether Medicaid Managed Care RI 352 15.6% — UnitedHealth Group UnitedHealthcare Community Plan - New Jersey FamilyCare Medicaid Managed Care NJ 279K 15.5% — Community Care Plan Community Care Plan (MMA/SMI & Florida Healthy Kids) Medicaid Managed Care FL 16K 15.5% — Wellcare Wellcare Medicare Advantage — 2K 15.5% — UnitedHealth Group UnitedHealthcare Medicare Advantage - Contract H0251 Medicare Advantage — 32K 15.4% — Johns Hopkins Medicine Johns Hopkins Advantage MD (VA HMO) - Contract H1339 Medicare Advantage VA 13 15.4% — MetroPlus Health Plan MetroPlus Medicaid Managed Care Medicaid Managed Care NY 52K 15.4% — Healthfirst Health and Recovery Plan (HARP) Medicaid Managed Care NY 54K 15.3% — Wellcare Wellcare Medicare Advantage — 53K 15.3% — UnitedHealth Group UnitedHealthcare Medicare Advantage - Contract H5008 Medicare Advantage — 28K 15.2% — CVS Health / Aetna Aetna Better Health of Louisiana Medicaid Managed Care LA 80K 15.2% — Humana Humana Healthy Horizons in Ohio Medicaid Managed Care OH 61K 15.1% — Centene WellCare of North Carolina Medicaid Managed Care NC 147K 15.1% — Humana Humana Healthy Horizons in Ohio Medicaid Managed Care OH 61K 15.1% — Excellus BlueCross BlueShield Excellus BCBS Managed Medicaid (MMC) Medicaid Managed Care NY 126K 15.0% — AmeriHealth Caritas AmeriHealth Caritas North Carolina Medicaid Managed Care NC 78K 15.0% 2 Humana / iCare iCare BadgerCare Plus Medicaid Managed Care WI 8K 15.0% — Molina Healthcare Molina Healthcare of Florida Medicaid Managed Care FL — 15.0% — Molina Healthcare Molina Healthcare of New Mexico (Turquoise Care) Medicaid Managed Care NM — 15.0% — Molina Healthcare Molina Healthcare of Texas CHIP RSA Medicaid CHIP Managed Care TX — 15.0% — Centene MHS Health Wisconsin (NHP line) Medicaid Managed Care WI 11K 15.0% — Centene WellCare of Kentucky Medicaid Managed Care KY 357K 14.9% — Wellcare Wellcare Medicare Advantage — 3K 14.8% — Centene Home State Health - Show Me Healthy Kids Medicaid Managed Care MO 18K 14.8% — Wellcare Wellcare Medicare Advantage — 14K 14.8% — Trillium Community Health Plan Trillium Community Health Plan Unclassified — 14K 14.7% — Wellcare Wellcare Medicare Advantage — 14K 14.7% — Wellcare Wellcare Medicare Advantage — 14K 14.7% — Johns Hopkins Medicine Johns Hopkins Advantage MD (PPO) - Contract H3890 Medicare Advantage MD 12K 14.7% — Wellcare Wellcare Medicare Advantage — 33K 14.6% — Commonwealth of Massachusetts Calendar Year 2025 Prior Authorization Metrics (program not named in document) Medicaid FFS MA — 14.6% — Wellcare Wellcare Medicare Advantage — 15K 14.6% — UnitedHealth Group UnitedHealthcare Medicare Advantage - Contract H4604 Medicare Advantage — 88K 14.6% — UnitedHealth Group UnitedHealthcare Medicare Advantage - Contract H3805 Medicare Advantage — 107K 14.5% — Excellus BlueCross BlueShield Excellus BCBS Child Health Plus CHIP Managed Care NY 18K 14.5% — UnitedHealth Group UnitedHealthcare Medicare Advantage - Contract H0421 Medicare Advantage — 4K 14.4% — Centene Trillium Community Health Plan - Southwest Medicaid Managed Care OR 10K 14.3% — Rocky Mountain Health Plans Rocky Mountain Health Plans - QHP On-Exchange Marketplace QHP CO 1K 14.2% 1 UnitedHealth Group Missouri HealthNet Medicaid Managed Care MO 69K 14.2% — Centene Carolina Complete Health Medicaid Managed Care NC 71K 14.1% — CVS Health / Aetna Aetna Better Health of Ohio (OhioRISE) Medicaid Managed Care OH 76K 14.1% — The Health Plan The Health Plan - West Virginia CHIP CHIP Managed Care WV 2K 14.1% — Molina Healthcare Molina Healthcare of Illinois (Medicaid) Medicaid Managed Care IL — 14.0% — EmblemHealth EmblemHealth Medicare H5991 Medicare Advantage NY 5K 14.0% — Oscar Health Oscar Health - Kansas Marketplace QHP KS — 14.0% — UnitedHealth Group Florida Managed Medical Assistance Medicaid Managed Care FL 71K 13.9% — Network Health (Wisconsin) Network Health ACA/exchange plans Marketplace QHP WI 11K 13.9% — MetroPlus Health Plan MetroPlus Child Health Plus CHIP Managed Care NY 2K 13.8% — EmblemHealth EmblemHealth Medicare H5228 Medicare Advantage NY 29 13.8% — HealthPartners HealthPartners Commercial Wisconsin Federally Facilitated Exchange (on-exchange QHP) plans Marketplace QHP WI 1K 13.7% — UnitedHealth Group Healthy Louisiana Medicaid Managed Care LA 136K 13.7% — Cascade Health Alliance Cascade Health Alliance Medicaid Managed Care OR — 13.7% — Wellcare Wellcare Medicare Advantage — 9K 13.6% — TrueCare TrueCare (Mississippi Medicaid) Medicaid Managed Care MS 34K 13.5% — UnitedHealth Group UnitedHealthcare Medicare Advantage - Contract H0169 Medicare Advantage — 40K 13.5% — UnitedHealth Group UnitedHealthcare Medicare Advantage H0169 Medicare Advantage — 40K 13.5% — Wellcare Wellcare Medicare Advantage — 28K 13.5% — Wellcare By ‘Ohana Health Plan Wellcare By ‘Ohana Health Plan Medicare Advantage — 28K 13.5% — UnitedHealth Group UnitedHealthcare Medicare Advantage - Contract H1285 Medicare Advantage — 21K 13.4% — Centene NH Healthy Families Medicaid Managed Care NH 40K 13.4% 1 Humana / iCare iCare Medicaid SSI Medicaid Managed Care WI 6K 13.3% — UnitedHealth Group UnitedHealthcare Medicare Advantage - Contract H2445 Medicare Advantage — 19K 13.2% — Wellcare Wellcare Medicare Advantage — 91K 13.2% — CVS Health / Aetna Aetna Medicare Advantage - contract H8332 Medicare Advantage — — 13.2% — Centene Iowa Total Care Medicaid Managed Care IA 155K 13.2% — Centene YouthCare (HealthChoice Illinois Medicaid) Medicaid Managed Care IL 10K 13.2% — Univera Healthcare Univera Healthcare MyHealth Plus (HARP) Medicaid Managed Care NY 498 13.1% — Molina Healthcare Molina Healthcare of Nebraska - Medicaid Medicaid Managed Care NE — 13.0% — Molina Healthcare Molina Marketplace South Carolina Marketplace QHP SC — 13.0% — Molina Healthcare Senior Whole Health of New York - MLTSS Medicaid Managed Care NY — 13.0% 1 CDPHP CDPHP Medicaid HARP Medicaid Managed Care NY 2K 13.0% — UnitedHealth Group UnitedHealthcare Medicare Advantage - Contract H2509 Medicare Advantage — 19K 12.9% — Excellus BlueCross BlueShield Excellus BCBS Blue Option Plus (HARP) Medicaid Managed Care NY 18K 12.9% — Molina Healthcare Molina Healthcare of Ohio (Medicaid) Medicaid Managed Care OH 68K 12.8% — Blue Cross Blue Shield of Arizona Individual Affordable Care Act Plan Members Marketplace QHP AZ 34K 12.8% — Healthfirst MLTC Medicaid Managed Care NY 30K 12.8% — Humana Humana Healthy Horizons in Kentucky Medicaid Managed Care KY 186K 12.8% — Centene Delaware First Health Medicaid Medicaid Managed Care DE 15K 12.8% — CVS Health / Aetna Aetna Medicare Advantage - contract H4523 Medicare Advantage — — 12.7% — Humana Humana Healthy Horizons in Indiana Medicaid Managed Care IN 26K 12.7% — Humana Humana H0783 Medicare Advantage — 2K 12.6% — Rocky Mountain Health Plans Rocky Mountain Health Plans Medicare Advantage Medicare Advantage CO 294 12.6% 1 Kaiser Permanente Kaiser Foundation Health Plan of the Northwest Medicare Advantage OR 62K 12.6% — UnitedHealth Group UnitedHealthcare Medicare Advantage - Contract H3256 Medicare Advantage — 18K 12.6% — Highmark Highmark Medicare Advantage contract H7710 Medicare Advantage DE 671 12.4% — CDPHP CDPHP Managed Medicaid Medicaid Managed Care NY 8K 12.3% — Highmark Highmark Medicare Advantage contract H5932 Medicare Advantage PA 7K 12.2% 1 Network Health (Wisconsin) Network Health Medicare Advantage Medicare Advantage WI 123K 12.2% — Wellmark Blue Cross and Blue Shield Wellmark Blue Cross and Blue Shield of South Dakota (FFE plans) Marketplace QHP SD 3K 12.2% — Centene Delaware First Health CHIP CHIP Managed Care DE 618 12.1% — Blue Cross Blue Shield of Arizona AZ Blue Health Choice (AHCCCS) Medicaid Managed Care AZ 72K 12.1% — Centene Sunflower Health Plan (KanCare) Medicaid Managed Care KS 82K 12.1% — MetroPlus Health Plan MetroPlus Medicare (H0423) Medicare Advantage NY 10K 12.0% — Martin's Point Health Care Generations Advantage LPPO - Medical (non-oncology) Medicare Advantage ME 568 12.0% — Elevance Health Anthem HealthKeepers Plus (Virginia Medicaid) Medicaid Managed Care VA 342K 11.9% — Molina Healthcare Molina Clinical Services, LLC (Mississippi) Medicaid Managed Care MS — 11.9% — Oscar Health Oscar Health - Tennessee Marketplace QHP TN — 11.9% — UnitedHealth Group UnitedHealthcare Medicare Advantage - Contract H3794 Medicare Advantage — 15K 11.9% — UnitedHealth Group UnitedHealthcare Medicare Advantage - Contract H7464 Medicare Advantage — 12K 11.9% — CDPHP CDPHP Medicare HMO Medicare Advantage NY 19K 11.9% — Highmark Highmark QHP (federal Marketplace) - West Virginia Marketplace QHP WV 25K 11.8% 1 Yamhill Community Care Yamhill Community Care Medicaid Managed Care OR 14K 11.8% — Humana Humana H2463 Medicare Advantage — 2K 11.8% — Mass General Brigham Mass General Brigham Advantage PPO Medicare Advantage MA 11K 11.7% — Humana Humana Healthy Horizons in Virginia Medicaid Managed Care VA 33K 11.7% — UnitedHealth Group UnitedHealthcare Medicare Advantage - Contract H0764 Medicare Advantage — 499 11.6% — Elevance Health Anthem HealthPlus New York Child Health Plus CHIP Managed Care NY — 11.6% — Community Health Choice Community Health Choice STAR & STAR+PLUS (combined) Medicaid Managed Care TX 52K 11.5% 1 UnitedHealth Group UnitedHealthcare Medicare Advantage - Contract H3387 Medicare Advantage — 41K 11.5% — Wellcare Wellcare Medicare Advantage — 24K 11.5% — CVS Health / Aetna Aetna Medicare Advantage - contract H3219 Medicare Advantage — — 11.5% — UnitedHealth Group UnitedHealthcare Medicare Advantage - Contract H2292 Medicare Advantage — 280 11.4% — Centene Sunshine Health Children's Medical Services (Title XXI) CHIP Managed Care FL 37K 11.4% — Humana / iCare iCare Family Care Partnership Medicaid Managed Care WI 3K 11.3% — Kaiser Permanente Kaiser Permanente Northern California (H8794) Medicare Advantage CA 40K 11.3% — CVS Health / Aetna Aetna Medicare Advantage - contract H4711 Medicare Advantage — — 11.3% — Health Share of Oregon Health Share of Oregon Medicaid Managed Care OR — 11.3% — UnitedHealth Group UnitedHealthcare Medicare Advantage - Contract H2247 Medicare Advantage — 19K 11.3% — Independent Health Independent Health Medicare H3344 Medicare Advantage NY 7K 11.2% — UnitedHealth Group Virginia Cardinal Care LTSS Medicaid Managed Care VA 49K 11.1% — Wellmark Blue Cross and Blue Shield Wellmark Blue Cross and Blue Shield of Iowa (FFE plans) Marketplace QHP IA 25K 11.1% — Driscoll Health Plan Driscoll Health Plan CHIP CHIP Managed Care TX — 11.0% — Mass General Brigham Mass General Brigham Advantage Secure HMO-POS Medicare Advantage MA 2K 11.0% — Kaiser Permanente Kaiser Permanente Southern California (H8794) Medicare Advantage CA 34K 11.0% — CVS Health / Aetna Aetna Medicare Advantage - contract H3288 Medicare Advantage — — 10.9% — Contra Costa Health Contra Costa Health Plan (Medi-Cal) Medicaid Managed Care CA 62K 10.9% 2 Humana Humana Healthy Horizons in South Carolina Medicaid Managed Care SC 15K 10.9% — UnitedHealth Group Virginia Cardinal Care Medicaid Medicaid Managed Care VA 57K 10.9% — CVS Health / Aetna Aetna Better Health of Oklahoma Medicaid Managed Care OK 64K 10.8% — UnitedHealth Group UnitedHealthcare Medicare Advantage - Contract H5420 Medicare Advantage — 13K 10.8% — AmeriHealth Caritas AmeriHealth Caritas Louisiana Medicaid Managed Care LA 87K 10.8% 2 CVS Health / Aetna Aetna Medicare Advantage - contract H4835 Medicare Advantage — — 10.7% — UnitedHealth Group UnitedHealthcare Medicare Advantage - Contract H0624 Medicare Advantage — 10K 10.7% — Kaiser Permanente Kaiser Permanente Northern California Medicare Advantage CA 145K 10.5% — UnitedHealth Group UnitedHealthcare Medicare Advantage - Contract H6706 Medicare Advantage — 133 10.5% — Centene Sunshine Health Children's Medical Services (Title XIX) Medicaid Managed Care FL 297K 10.5% — CVS Health / Aetna Aetna Medicare Advantage - contract H3928 Medicare Advantage — — 10.4% — CVS Health / Aetna Aetna Medicare Advantage - contract H3239 Medicare Advantage — — 10.4% — UnitedHealth Group Washington Apple Health Medicaid Managed Care WA 37K 10.4% — CVS Health / Aetna Aetna Medicare Advantage - contract H1609 Medicare Advantage — — 10.4% — Wellcare Wellcare Medicare Advantage — 2K 10.3% — Wellcare Wellcare Medicare Advantage — 2K 10.3% — Wyoming Department of Health Wyoming Medicaid Utilization Management (FFS) Medicaid FFS WY 11K 10.3% 1 Wyoming Department of Health, Healthcare Financing, Utilization Management Wyoming Department of Health, Healthcare Financing, Utilization Management Medicaid FFS WY 11K 10.3% 1 Elevance Health Wellpoint New Jersey (NJ FamilyCare) Medicaid Managed Care NJ — 10.3% — Elevance Health Wellpoint Washington (Apple Health) Medicaid Managed Care WA 68K 10.3% — Healthfirst Contract H9678 Medicare Advantage NY 11K 10.3% — UnitedHealth Group UnitedHealthcare Medicare Advantage - Contract H0321 Medicare Advantage — 39K 10.2% — Mississippi Division of Medicaid Mississippi Medicaid Fee-for-Service Medicaid FFS MS 60K 10.2% 2 Mass General Brigham Mass General Brigham Health Plan - MGB ACO (MassHealth) Medicaid Managed Care MA 41K 10.1% — CountyCare Health Plan (Cook County Health) CountyCare Health Plan (HealthChoice Illinois Medicaid) Medicaid Managed Care IL 242K 10.0% 1 CareSource CareSource MyCare Ohio Medicare-Medicaid Plan OH 61K 10.0% — CDPHP CDPHP Medicare PPO Medicare Advantage NY 4K 10.0% — Molina Healthcare Molina Healthcare of Wisconsin - BadgerCare Plus Medicaid Managed Care WI — 10.0% — CVS Health / Aetna Aetna Better Health of New York Medicaid Managed Care NY 53K 10.0% — Healthfirst Contract H5989 Medicare Advantage NY 52K 10.0% — Rocky Mountain Health Plans Rocky Mountain Health Plans PRIME (Medicaid) Medicaid Managed Care CO 1K 10.0% 1 Northeast Health Partners Northeast Health Partners (Regional Accountable Entity) Medicaid Managed Care CO 4K 9.9% 2 Texas Children's Health Plan Texas Children's Health Plan (STAR/CHIP/STAR Kids combined) Multiple (combined) TX 128K 9.9% — UnitedHealth Group UnitedHealthcare Medicare Advantage - Contract H3113 Medicare Advantage — 36K 9.9% — Sentara Health Sentara Health Plans - Commercial Marketplace QHP VA 120K 9.8% — Sanford Health Plan Sanford Health Plan Medicare Advantage — 82 9.8% — UnitedHealth Group Arizona Developmental Disabilities Program Medicaid Managed Care AZ 10K 9.7% — Humana / iCare iCare Medicare Plan Medicare Advantage WI 4K 9.7% — Kaiser Permanente Kaiser Foundation Health Plan of Colorado Medicare Advantage CO 69K 9.6% — CVS Health / Aetna Aetna Medicare Advantage - contract H1692 Medicare Advantage — — 9.6% — Healthfirst Contract H1722 Medicare Advantage NY 3K 9.6% 1 Priority Health Priority Health Medicare Advantage MI 13K 9.6% — UnitedHealth Group Florida Long Term Care Medicaid Managed Care FL 43K 9.5% — CVS Health / Aetna Aetna Medicare Advantage - contract H3931 Medicare Advantage — — 9.5% — Humana Humana H0473 Medicare Advantage — 27K 9.5% — Kaiser Permanente Kaiser Foundation Health Plan of Colorado - CHIP CHIP Managed Care CO 1K 9.4% — Humana Humana H8908 Medicare Advantage — 61K 9.3% — Humana Humana R4182 Medicare Advantage — 19K 9.2% — Molina Healthcare Molina MyCare Ohio Medicare-Medicaid Plan OH 28K 9.2% — UnitedHealth Group UnitedHealthcare Medicare Advantage - Contract H2385 Medicare Advantage — 601 9.2% — Rocky Mountain Health Plans Rocky Mountain Health Plans - QHP Off-Exchange (Commercial) Marketplace QHP CO 7K 9.1% — Santa Clara Family Health Plan SCFHP DualConnect (HMO D-SNP) Medicare Advantage CA 13K 9.1% — UnitedHealth Group UnitedHealthcare Medicare Advantage - Contract H5322 Medicare Advantage — 136K 9.0% — CHRISTUS Health Plan CHRISTUS Health Plan Medicare Advantage — 399 9.0% 1 UnitedHealth Group Michigan Comprehensive Health Care Program Medicaid Managed Care MI 73K 9.0% — Elevance Health Medicaid Managed Care IN 102K 9.0% — UnitedHealth Group Texas CHIP CHIP Managed Care TX 577 9.0% — Blue Cross and Blue Shield of Nebraska BCBSNE Qualified Health Plans Marketplace QHP NE — 9.0% — GuideWell / Florida Blue BlueMedicare Classic (HMO) / Preferred (HMO) / Premier (HMO) Medicare Advantage FL — 9.0% — Molina Healthcare Molina Complete Care of Arizona (AHCCCS Medicaid) Medicaid Managed Care AZ — 9.0% — UnitedHealth Group New York Wellness 4Me (HARP) Medicaid Managed Care NY 4K 9.0% 1 Independent Health Independent Health Medicare H3362 Medicare Advantage NY 117K 9.0% — Kaiser Permanente Kaiser Permanente Northern California - Medi-Cal Medicaid Managed Care CA 25K 9.0% — Elevance Health Wellpoint District of Columbia Medicaid Managed Care DC — 8.9% — Humana Humana H3533 Medicare Advantage — 45K 8.9% — Rocky Mountain Health Plans Rocky Mountain Health Plans RAE (Medicaid Regional Accountable Entity) Medicaid Managed Care CO 8K 8.9% 1 Community Health Choice Community Health Choice D-SNP Medicare Advantage TX 1K 8.8% — Highmark Highmark Medicaid - New York Medicaid Managed Care NY — 8.7% — UnitedHealth Group District of Columbia Dual Choice Program Medicare-Medicaid Plan DC 23 8.7% — CVS Health / Aetna Aetna Medicare Advantage - contract H5325 Medicare Advantage — — 8.7% — UnitedHealth Group Washington Apple Health Expansion Medicaid Managed Care WA 21K 8.6% — Elevance Health Wellpoint Texas Medicaid & CHIP (all) Medicaid Managed Care TX — 8.6% — HealthPartners HealthPartners Minnesota Health Care Programs (Medicaid) Medicaid Managed Care MN 12K 8.5% — Humana Humana Healthy Horizons in Oklahoma Medicaid Managed Care OK 86K 8.5% — Elevance Health Wellpoint Tennessee (TennCare) Medicaid Managed Care TN — 8.5% — Kaiser Permanente Kaiser Foundation Health Plan of Colorado (H3138) Medicare Advantage CO 876 8.5% — Blue Cross Blue Shield of Arizona AZ Blue Health Choice Pathway (D-SNP) Medicare Advantage AZ 12K 8.4% — Humana Humana H0028 Medicare Advantage — 609K 8.4% — Hawaii Med-QUEST Med-QUEST aggregate (QUEST Integration plans plus FFS) Medicaid FFS HI 122K 8.3% — CVS Health / Aetna Aetna Medicare Advantage - contract H2293 Medicare Advantage — — 8.3% — Humana Humana H5178 Medicare Advantage — 567 8.3% — UnitedHealth Group Nebraska Heritage Health Medicaid Managed Care NE 42K 8.3% — Highmark Highmark QHP (federal Marketplace) - Delaware Marketplace QHP DE 16K 8.3% — Colorado Access Colorado Access Medicaid Managed Care CO 17K 8.2% 1 Healthfirst Contract H3359 Medicare Advantage NY 764K 8.2% — Priority Health Priority Health Medicare PPO Medicare Advantage MI 96K 8.2% — CVS Health / Aetna Aetna Medicare Advantage - contract H1608 Medicare Advantage — — 8.2% — Humana Humana H6622 Medicare Advantage — 473K 8.1% — UnitedHealth Group UnitedHealthcare Medicare Advantage - Contract H2582 Medicare Advantage — 86 8.1% — Elevance Health Medicaid Managed Care IN 425K 8.1% — UnitedHealth Group New Mexico Turquoise Care Medicaid Managed Care NM 6K 8.1% — UnitedHealth Group UnitedHealthcare Medicare Advantage - Contract H2272 Medicare Advantage — 3K 8.1% — GuideWell / Florida Blue BlueMedicare Patriot (PPO) / Select (PPO) / Value (PPO) Medicare Advantage FL — 8.0% — Molina Healthcare Molina Healthcare of Nebraska - CHIP CHIP Managed Care NE — 8.0% — Molina Healthcare Senior Whole Health of New York - Medicare Medicare Advantage NY — 8.0% — UnitedHealth Group Kentucky Medicaid Medicaid Managed Care KY 90K 8.0% — The Health Plan The Health Plan - Medicare (posted as PPO) Medicare Advantage WV 4K 7.9% — CareOregon Columbia Pacific CCO Medicaid Managed Care OR 16K 7.9% 2 CVS Health / Aetna Aetna Medicare Advantage - contract H5521 Medicare Advantage — — 7.9% — Humana Humana R7220 Medicare Advantage — 2K 7.9% — Humana Humana H1468 Medicare Advantage — 210K 7.8% — CVS Health / Aetna Aetna Medicare Advantage - contract H7149 Medicare Advantage — — 7.8% — UnitedHealth Group Wisconsin Medicaid Medicaid Managed Care WI 81K 7.8% — EmblemHealth EmblemHealth Medicare H3330 Medicare Advantage NY 73K 7.7% — Humana Humana H8145 Medicare Advantage — 29K 7.7% — Rocky Mountain Health Plans Rocky Mountain Health Plans - CHP+ (Child Health Plan Plus) CHIP Managed Care CO 6K 7.7% — CVS Health / Aetna Aetna Better Health of Texas Medicaid Managed Care TX 41K 7.7% — CVS Health / Aetna Aetna Medicare Advantage - contract H0628 Medicare Advantage — — 7.7% — CVS Health / Aetna Aetna Medicare Advantage - contract H1109 Medicare Advantage — — 7.7% — Humana Humana R1532 Medicare Advantage — 5K 7.6% — CareOregon Jackson Care Connect Medicaid Managed Care OR 35K 7.6% 2 Humana Humana H4141 Medicare Advantage — 116K 7.6% — Humana Humana H5525 Medicare Advantage — 282K 7.6% — Centene Community Health Plan of Imperial Valley Medi-Cal Medicaid Managed Care CA 57K 7.6% — UnitedHealth Group Rhode Island Medicaid Medicaid Managed Care RI 30K 7.6% — Martin's Point Health Care Generations Advantage HMO - Medical (non-oncology) Medicare Advantage ME 8K 7.5% — CVS Health / Aetna Aetna Medicare Advantage - contract H5302 Medicare Advantage — — 7.4% — CHRISTUS Health CHRISTUS Health Plan (LA Marketplace) Marketplace QHP LA 351 7.4% — Point32Health Tufts Health Together Managed Care Organization (MCO) Medicaid Managed Care MA 2K 7.4% — UnitedHealth Group Indiana Hoosier Care Connect Medicaid Managed Care IN 6K 7.4% — Humana Humana H7284 Medicare Advantage — 36K 7.4% — UnitedHealth Group UnitedHealthcare Medicare Advantage - Contract H0609 Medicare Advantage — 705K 7.3% — CVS Health / Aetna Aetna Medicare Advantage - contract H3312 Medicare Advantage — — 7.3% — UnitedHealth Group UnitedHealthcare Medicare Advantage - Contract H1360 Medicare Advantage — 2K 7.3% — CVS Health / Aetna Aetna Medicare Advantage - contract H3748 Medicare Advantage — — 7.3% — CVS Health / Aetna Aetna Medicare Advantage - contract H8597 Medicare Advantage — — 7.3% — Centene Buckeye MyCare Ohio Medicare-Medicaid Plan OH 20K 7.2% — CVS Health / Aetna Aetna Medicare Advantage - contract H2056 Medicare Advantage — — 7.2% — Humana Humana H5970 Medicare Advantage — 88K 7.2% — Community First Health Plans Community First Texas Medicaid STAR+PLUS Medicaid Managed Care TX 9K 7.2% 2 CareFirst BlueCross BlueShield CareFirst BlueCross BlueShield Community Health Plan Maryland (CareFirst CHPMD) Medicaid Managed Care MD 28K 7.2% — Humana Humana H5377 Medicare Advantage — 1K 7.2% — Humana Humana H2486 Medicare Advantage — 9K 7.1% — Kaiser Permanente Kaiser Mid-Atlantic States - Maryland Medicaid Medicaid Managed Care MD — 7.1% — CVS Health / Aetna Aetna Medicare Advantage - contract H3146 Medicare Advantage — — 7.1% — Kaiser Permanente Kaiser Permanente Hawaii Medicare Advantage HI 22K 7.1% — Humana Humana H1036 Medicare Advantage — 1.3M 7.0% — Priority Health Priority Health Medicare HMO/HMO-POS Medicare Advantage MI 144K 7.0% — The Health Plan The Health Plan - Medicare HMO Medicare Advantage WV 10K 7.0% — CVS Health / Aetna Aetna Medicare Advantage - contract H5593 Medicare Advantage — — 7.0% — Molina Healthcare Molina Healthcare of Wisconsin - Medicaid SSI Medicaid Managed Care WI — 7.0% — CVS Health / Aetna Aetna Medicare Advantage - contract H5522 Medicare Advantage — — 7.0% — Ohio Department of Medicaid MyCare Ohio - all plans combined Medicare-Medicaid Plan OH 188K 7.0% — Humana Humana H5216 Medicare Advantage — 4.2M 6.9% — Fallon Health Fallon Health – Atrius Health Care Collaborative (365 Care) Medicaid Managed Care MA 18K 6.8% — CVS Health / Aetna Aetna Medicare Advantage - contract H2663 Medicare Advantage — — 6.8% — Elevance Health Medicaid Managed Care IN 122K 6.8% — Molina Healthcare Molina Healthcare of Mississippi, Inc. Medicaid Managed Care MS — 6.7% — Humana Humana R0110 Medicare Advantage — 65K 6.6% — UnitedHealth Group District of Columbia Dual Choice - Medicaid LTSS Medicare-Medicaid Plan DC 12K 6.6% — CVS Health / Aetna Aetna Medicare Advantage - contract H5337 Medicare Advantage — — 6.6% — CVS Health / Aetna Aetna Better Health Premier Plan (Medicare-Medicaid) Medicare-Medicaid Plan IL — 6.6% — UnitedHealth Group Tennessee TennCare Medicaid Managed Care TN 104K 6.5% — Humana Humana R5361 Medicare Advantage — 5K 6.5% — Univera Healthcare Univera Healthcare Child Health Plus CHIP Managed Care NY 215 6.5% — Blue Cross and Blue Shield of Louisiana HMO Louisiana, Inc. Marketplace QHP LA 63K 6.5% — Blue Cross and Blue Shield of Louisiana Louisiana Health Services Insurance Company (LHSIC) Marketplace QHP LA 11K 6.4% — Connecticut DSS Connecticut Medicaid (HUSKY) FFS - Medical Medicaid FFS CT 255K 6.4% — Kaiser Permanente Kaiser Permanente Southern California - Medi-Cal Medicaid Managed Care CA 57K 6.4% — MetroPlus Health Plan MetroPlus Medicaid Advantage Plus Medicaid Managed Care NY 1K 6.4% 1 UnitedHealth Group Hawaii Quest Integration Medicaid Managed Care HI 20K 6.4% — Centene CalViva Health Medi-Cal Medicaid Managed Care CA 310K 6.3% — HealthPartners HealthPartners Medicare Advantage and Minnesota Senior Health Options (MSHO), combined Multiple (combined) MN 12K 6.3% — Univera Healthcare Univera Healthcare Medicare PPO Medicare Advantage NY 3K 6.2% — UnitedHealth Group UnitedHealthcare Medicare Advantage - Contract H2531 Medicare Advantage — 7K 6.2% — Humana Humana H4461 Medicare Advantage — 280K 6.2% — Excellus BlueCross BlueShield Excellus BCBS Medicare PPO Medicare Advantage NY 118K 6.2% — Kaiser Permanente Kaiser Foundation Health Plan of Washington Medicare Advantage WA 185K 6.1% — Humana Humana H4623 Medicare Advantage — 20K 6.1% — Highmark Highmark QHP (federal Marketplace) - Pennsylvania Marketplace QHP PA 78K 6.1% 1 Sanford Health Plan Sanford Health Plan Medicare Advantage — 313 6.1% — Humana Humana H1951 Medicare Advantage — 313K 6.1% — Humana Humana H2875 Medicare Advantage — 644 6.1% — CVS Health / Aetna Aetna Medicare Advantage - contract H3959 Medicare Advantage — — 6.1% — CVS Health / Aetna Aetna Medicare Advantage - contract H7301 Medicare Advantage — — 6.0% — MJHS Health System Elderplan Medicare Advantage NY — 6.0% — Molina Healthcare Molina Healthcare of Texas STAR+PLUS Medicaid Managed Care TX — 6.0% — CVS Health / Aetna Aetna Medicare Advantage - contract H1206 Medicare Advantage — — 6.0% — Keystone 65 HMO Keystone 65 HMO Medicare Advantage — 123K 5.9% — CVS Health / Aetna Aetna Better Health Premier Plan Michigan Medicare-Medicaid Plan MI — 5.9% — Alignment Healthcare Alignment Health Plan H3443 Medicare Advantage — 14K 5.8% — CVS Health / Aetna Aetna Medicare Advantage - contract H5793 Medicare Advantage — — 5.8% — UnitedHealth Group MississippiCAN Medicaid Managed Care MS 7K 5.7% — CMS Prior Authorization Metrics 2025 MEDICARE-H1994 CMS Prior Authorization Metrics 2025 MEDICARE-H1994 Medicare Advantage — 43K 5.7% — UnitedHealth Group Ohio Public Health Care Program Medicaid Managed Care OH 113K 5.7% — UnitedHealth Group UnitedHealthcare Community Plan of Ohio Medicaid Managed Care OH 113K 5.7% — UnitedHealth Group North Carolina Medicaid Managed Care Medicaid Managed Care NC 153K 5.7% — Blue Cross Blue Shield of Arizona Medicare Advantage Medicare Advantage AZ 37K 5.6% — Humana Humana H0292 Medicare Advantage — 16K 5.5% — Kaiser Permanente Kaiser Foundation Health Plan of the Mid-Atlantic States Medicare Advantage MD 90K 5.5% 1 Humana Humana R5826 Medicare Advantage — 7K 5.5% — CVS Health / Aetna Aetna Medicare Advantage - contract H3597 Medicare Advantage — — 5.5% — UnitedHealth Group Texas STAR Kids Medicaid Managed Care TX 18K 5.4% — Point32Health Tufts Health Together with UMass Memorial Health Medicaid Managed Care MA 6K 5.2% — Michigan Department of Health and Human Services Michigan Medicaid Home and Community Based Services (Aging and Community Services Division, incl. Brain Injury Services and Community Transition Services) - Fee-for-Service Medicaid FFS MI 3K 5.2% 1 Highmark Highmark Medicare Advantage contract H5106 Medicare Advantage — 41K 5.2% — Community First Health Plans Community First Texas Medicaid STAR Kids Medicaid Managed Care TX 12K 5.2% 1 Geisinger Health Geisinger Health Plan (all lines of business, aggregated) Medicare Advantage PA 311K 5.1% 1 Indiana Family and Social Services Administration Indiana Health Coverage Programs (fee-for-service) Medicaid FFS IN 205K 5.1% 2 Humana Humana H5619 Medicare Advantage — 1.2M 5.1% — Sentara Health Sentara Health Plans - Medicare Medicare Advantage VA 50K 5.1% 1 Univera Healthcare Univera Healthcare Medicare HMO Medicare Advantage NY 33K 5.0% — GuideWell / Florida Blue BlueOptions (PPO) / BlueSelect (EPO) Marketplace QHP FL — 5.0% — Molina Healthcare Molina Healthcare of New York Child Health Plus CHIP Managed Care NY — 5.0% — Molina Healthcare Molina Healthcare of Texas CHIP Perinate RSA (at or below 185% FPL) CHIP Managed Care TX — 5.0% 1 Martin's Point Health Care Generations Advantage HMO - Optum oncology/radiology Medicare Advantage ME 7K 4.9% — Blue Cross & Blue Shield of Rhode Island Blue Cross & Blue Shield of Rhode Island (all impacted lines combined) Multiple (combined) RI 68K 4.9% — Excellus BlueCross BlueShield Excellus BCBS Medicare HMO Medicare Advantage NY 103K 4.9% — Devoted Health Devoted Health (all Medicare Advantage contracts combined) Medicare Advantage — — 4.9% — Macomb County Community Mental Health Macomb County Community Mental Health Medicaid Managed Care MI 48K 4.9% — Humana Humana Healthy Horizons in Louisiana Medicaid Managed Care LA 36K 4.9% — CHRISTUS Health CHRISTUS Health Plan (TX Marketplace) Marketplace QHP TX 3K 4.8% — Kaiser Permanente Kaiser Foundation Health Plan (Hawaii QHP) Marketplace QHP HI 2K 4.8% — UnitedHealth Group UnitedHealthcare Medicare Advantage - Contract H4514 Medicare Advantage — 227K 4.8% — Sanford Health Plan Sanford Health Plan Medicare Advantage — 1K 4.7% — UnitedHealth Group Kansas KanCare Medicaid Managed Care KS 94K 4.7% — Community First Health Plans Community First Texas Medicaid STAR Medicaid Managed Care TX 20K 4.7% 2 UnitedHealth Group Arizona Long Term Care Medicaid Managed Care AZ 46K 4.6% — Blue Cross Blue Shield of Massachusetts BCBSMA Medicare Advantage HMO Medicare Advantage MA — 4.6% — Community First Health Plans Community First CHIP CHIP Managed Care TX 1K 4.6% 1 UnitedHealth Group UnitedHealthcare Medicare Advantage - Contract H1278 Medicare Advantage — 213K 4.5% — Point32Health Tufts Health One Care Medicare-Medicaid Plan MA 10K 4.5% — Personal Choice 65SM PPO Personal Choice 65SM PPO Medicare Advantage — 71K 4.4% — Blue Cross Blue Shield of Massachusetts BCBSMA Medicare Advantage PPO Medicare Advantage MA — 4.4% — Elevance Health Wellpoint Iowa Medicaid Managed Care IA — 4.4% — UnitedHealth Group UnitedHealthcare MyCare Ohio Medicare-Medicaid Plan OH 18K 4.4% — Humana Humana H7617 Medicare Advantage — 23K 4.3% — UnitedHealth Group UnitedHealthcare Medicare Advantage - Contract H2226 Medicare Advantage — 13K 4.3% — Highmark Highmark Medicare Advantage contract H8166 Medicare Advantage — 27K 4.1% — UnitedHealth Group Pennsylvania CHIP CHIP Managed Care PA 900 4.1% — UnitedHealth Group UnitedHealthcare Medicare Advantage - Contract R6801 Medicare Advantage — 89K 4.0% — Santa Clara Family Health Plan SCFHP Medi-Cal Medicaid Managed Care CA 182K 4.0% — Blue Cross and Blue Shield of Nebraska BCBSNE Medicare Advantage HMO Medicare Advantage NE — 4.0% — Blue Cross and Blue Shield of Nebraska BCBSNE Medicare Advantage PPO Medicare Advantage NE — 4.0% — Molina Healthcare Molina Healthcare of Idaho (Medicaid Plus) Medicaid Managed Care ID — 4.0% — Molina Healthcare Molina Healthcare of Texas CHIP Perinate MHT (at or below 185% FPL) CHIP Managed Care TX — 4.0% 1 Point32Health Tufts Health Together with Cambridge Health Alliance (CHA) Medicaid Managed Care MA 4K 4.0% — UnitedHealth Group Indiana PathWays for Aging Medicaid Managed Care IN 55K 4.0% — Wisconsin Department of Health Services Wisconsin Medicaid (ForwardHealth) -- specific program/agency not named in document Medicaid FFS WI 165K 4.0% 2 Blue Cross and Blue Shield of North Carolina Experience Health Medicare Advantage (HMO) Medicare Advantage NC — 3.9% — Highmark Highmark Medicare Advantage contract H3916 Medicare Advantage — 463K 3.9% — Highmark Highmark Medicaid - West Virginia Medicaid Managed Care WV 1K 3.9% — Highmark Highmark Medicaid - Pennsylvania Medicaid Managed Care PA 22K 3.8% — Humana Humana Healthy Horizons in Illinois Medicaid Managed Care IL 15K 3.7% 1 UnitedHealth Group MississippiCAN CHIP CHIP Managed Care MS 616 3.7% — Alignment Healthcare Alignment Health Plan H5296 Medicare Advantage — 44K 3.7% — Alignment Healthcare Alignment Health Plan H5472 Medicare Advantage — 9K 3.7% — CVS Health / Aetna Aetna MyCare Ohio Medicare-Medicaid Plan OH 61K 3.6% — Highmark Highmark QHP (federal Marketplace) - New York Marketplace QHP NY 1K 3.4% — Blue Cross and Blue Shield of Kansas Blue Cross and Blue Shield of Kansas - Qualified Health Plans Marketplace QHP KS 4K 3.4% — Providence Health Plan Providence Medicare Advantage Plans Medicare Advantage — 115K 3.4% — UnitedHealth Group UnitedHealthcare Medicare Advantage - Contract H4527 Medicare Advantage — 258K 3.4% — Humana Humana H2029 Medicare Advantage — 654 3.4% — Highmark Highmark Medicare Advantage contract H3957 Medicare Advantage — 98K 3.3% — Blue Cross and Blue Shield of Kansas Blue Cross and Blue Shield of Kansas Medicare Advantage Medicare Advantage KS 2K 3.2% — Healthfirst Medicaid Only Services for Medicaid Advantage Plus Medicaid Managed Care NY 71K 3.2% — Kaiser Permanente Kaiser Foundation Health Plan of Georgia Medicare Advantage GA 52K 3.1% — Group Health Cooperative of South Central Wisconsin GHC-SCW Qualified Health Plan (Marketplace) Marketplace QHP WI — 3.0% — Blue Cross and Blue Shield of North Carolina Blue Medicare Advantage (PPO) Medicare Advantage NC — 3.0% — Alameda Alliance for Health Alameda Alliance for Health Medicaid Managed Care CA 117K 3.0% — Blue Cross and Blue Shield of Alabama Blue Cross and Blue Shield of Alabama Unclassified — 26K 2.9% — Alignment Healthcare Alignment Health Plan H8832 Medicare Advantage — 4K 2.9% — Alignment Healthcare Alignment Health Plan H4961 Medicare Advantage — 5K 2.9% — Martin's Point Health Care Generations Advantage LPPO - Optum oncology/radiology Medicare Advantage ME 387 2.8% — Wellcare Wellcare Medicare Advantage — 120K 2.8% — Community First Health Plans University Community Care Plan (Marketplace) Marketplace QHP TX 3K 2.8% 2 Alliance Health Alliance Health (NC Behavioral Health I/DD Tailored Plan) Medicaid Managed Care NC 98K 2.8% — Utah DHHS Utah Medicaid Medicaid FFS UT 30K 2.8% — Blue Cross and Blue Shield of North Carolina Healthy Blue + Medicare (HMO-POS D-SNP) Medicare Advantage NC — 2.7% — Horizon Blue Cross Blue Shield of New Jersey Horizon NJ TotalCare (HMO D-SNP) Medicare Advantage NJ — 2.7% — Community First Health Plans Community First Medicare Advantage (Alamo & D-SNP) Medicare Advantage TX 508 2.6% 2 Humana Humana Healthy Horizons in Florida Medicaid Managed Care FL 747K 2.6% — Kaiser Permanente Kaiser Permanente Hawaii - Medicaid Medicaid Managed Care HI 10K 2.6% — UnitedHealth Group UnitedHealthcare Medicare Advantage - Contract H9239 Medicare Advantage — 6K 2.5% — Centene Health Net Medi-Cal Medicaid Managed Care CA 3.1M 2.5% — CVS Health / Aetna Aetna Medicare Advantage - contract H0523 Medicare Advantage — — 2.4% — UnitedHealth Group UnitedHealthcare Community Plan - Texas STAR+PLUS Medicaid Managed Care TX 130K 2.3% — Sendero Health Plans Sendero Health Plans (IdealCare marketplace) Marketplace QHP TX — 2.2% — Alignment Healthcare Alignment Health Plan H3815 Medicare Advantage — 838K 2.1% — Alignment Healthcare Alignment Health Plan H7074 Medicare Advantage — 380 2.1% — Inland Empire Health Plan IEHP Covered California Marketplace QHP CA 379K 2.1% — Alaska Department of Health Alaska Medicaid (fee-for-service) Medicaid FFS AK 430K 2.1% — CVS Health / Aetna Aetna Medicare Advantage - contract H4982 Medicare Advantage — — 2.0% — Inland Empire Health Plan IEHP DualChoice (HMO D-SNP) Medicare Advantage CA 93K 2.0% — Group Health Cooperative of South Central Wisconsin GHC-SCW BadgerCare Plus (WI Medicaid) Medicaid Managed Care WI — 2.0% — Molina Healthcare Molina Healthcare of California (Medi-Cal) Medicaid Managed Care CA — 2.0% — Centene Wellcare By Health Net H3561 Medicare Advantage CA 290K 2.0% — San Francisco Health Plan San Francisco Health Plan (Medi-Cal) Medicaid Managed Care CA 63K 2.0% — Gold Coast Health Plan Gold Coast Health Plan Medicaid Managed Care CA 319K 2.0% — Centene Wellcare By Health Net H0562 Medicare Advantage CA 185K 1.9% — L.A. Care Health Plan L.A. Care Medi-Cal Marketplace QHP CA 2.2M 1.9% — SCAN Health Plan SCAN Health Plan (all Medicare Advantage contracts combined) Medicare Advantage — 2.1M 1.9% — UnitedHealth Group UnitedHealthcare Medicare Advantage - Contract H0543 Medicare Advantage — 1.6M 1.8% — CalOptima Health CalOptima Health Medi-Cal Medicaid Managed Care CA 965K 1.7% — Central California Alliance for Health Central California Alliance for Health Medicaid Managed Care CA 518K 1.6% — Elevance Health Medicaid Managed Care IN 404K 1.5% — Highmark Highmark Medicaid - Delaware Medicaid Managed Care DE 32K 1.5% — Highmark Highmark Medicare Advantage contract H3384 Medicare Advantage — 39K 1.5% — Highmark Highmark Medicare Advantage contract H5526 Medicare Advantage — 26K 1.4% — CalOptima Health CalOptima Health OneCare (HMO D-SNP) Medicare Advantage CA 95K 1.4% — Centene Sunshine Health Long-Term Care Medicaid Managed Care FL 135K 1.4% — UnitedHealth Group UnitedHealthcare Medicare Advantage - Contract H6824 Medicare Advantage — 153 1.3% — UnitedHealth Group UnitedHealthcare Medicare Advantage - Contract H5652 Medicare Advantage — 3K 1.2% 1 Elevance Health Anthem HealthPlus New York Medicaid Medicaid Managed Care NY — 1.2% — Inland Empire Health Plan IEHP Medi-Cal Medicaid Managed Care CA 3.0M 1.1% — Peak Health Peak Health Medicare Advantage WV 937 1.1% 1 L.A. Care Health Plan L.A. Care Medicare Plus (HMO D-SNP) Marketplace QHP CA 284K 1.0% — GuideWell / Florida Blue myBlue (HMO) / BlueCare (HMO-POS) Marketplace QHP FL — 1.0% — Connecticut DSS Connecticut Medicaid (HUSKY) FFS - Behavioral Health Medicaid FFS CT 105K 0.8% — UnitedHealth Group Idaho Medicaid Plus Medicaid Managed Care ID 2K 0.7% — UnitedHealth Group UnitedHealthcare Medicare Advantage - Contract H7833 Medicare Advantage — 2K 0.7% 1 Blue Shield of California Blue Shield of California Promise Health Plan (Medi-Cal) Medicaid Managed Care CA 892K 0.7% — Horizon Blue Cross Blue Shield of New Jersey Braven Health Medicare Advantage NJ — 0.5% — New Jersey DMAHS NJ FamilyCare / Medicaid Fee-for-Service Medicaid FFS NJ 890K 0.3% — AmeriHealth Caritas PerformCare Pennsylvania (HealthChoices BH) Medicaid Managed Care PA 15K 0.2% — CVS Health / Aetna Aetna Medicare Advantage - contract H0562 Medicare Advantage — — 0.0% 1 Kaiser Permanente Kaiser Permanente Hawaii H2704 Medicare Advantage HI 77 0.0% 1 Magellan Healthcare Wyoming High Fidelity Wraparound CME Medicaid FFS WY 1K 0.0% 1 Martin's Point Health Care Generations Advantage HMO - Behavioral Health Medicare Advantage ME 131 0.0% 2 Martin's Point Health Care Generations Advantage LPPO - Behavioral Health Medicare Advantage ME 17 0.0% 1 Molina Healthcare Senior Whole Health of New York - FIDE Medicaid Managed Care NY — 0.0% 1 UnitedHealth Group UnitedHealthcare Medicare Advantage - Contract H4032 Medicare Advantage — 8 0.0% 1 Wyoming Department of Health, Healthcare Finance, Home and Community Based Services Wyoming Department of Health, Healthcare Finance, Home and Community Based Services Medicaid FFS WY 32K 0.0% 1 Advanced Health Advanced Health Medicaid Managed Care OR 19K — — Blue Cross and Blue Shield of Minnesota Blue Cross and Blue Shield of Minnesota (Blue Cross plans) Marketplace QHP MN — — — Blue Cross and Blue Shield of Minnesota Blue Plus (Blue Cross and Blue Shield of Minnesota) Medicaid Managed Care MN — — — Community Health Plan of Washington CHPW Apple Health Medicaid Managed Care WA — — — Health Plan of San Mateo Health Plan of San Mateo Medicaid Managed Care CA 9K — —