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.

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54 of 658
filings in view
935K
standard requests
16.0%
volume-weighted denial rate
2
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
32
18
4
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
Medicaid Managed Care 872K 13 filings
Medicare-Medicaid Plan 61K 3 filings
CHIP Managed Care 2K 1 filings
Medicare Advantage 0 37 filings
Where the denial rate is highest
volume-weighted per state · floor 10K requests · top 10 · click a state for its filings
NJ 27.6% 56K · 1 filing
MD 23.2% 16K · 1 filing
FL 22.4% 43K · 1 filing
MI 22.1% 18K · 1 filing
KY 19.5% 123K · 1 filing
WV 19.3% 83K · 1 filing
VA 17.1% 108K · 1 filing
IL 15.6% 111K · 1 filing
LA 15.2% 80K · 1 filing
OK 10.8% 64K · 1 filing
Organizations by denials in view
standard denials summed over the slice · weighted rate beside each · top 10
CVS Health / Aetna 149K 16.0%
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 Advantage37 filingsMedicare Advantage: median 7.7%, middle half 6.8–10.4%, 90th percentile 11.3%7.7CVS Health / Aetna · Aetna Medicare Advantage - contract H5309 — 16.3%CVS Health / Aetna · Aetna Medicare Advantage - contract H8332 — 13.2%CVS Health / Aetna · Aetna Medicare Advantage - contract H4523 — 12.7%CVS Health / Aetna · Aetna Medicare Advantage - contract H3219 — 11.5%Medicaid Managed Care13 filingsMedicaid Managed Care: median 17.2%, middle half 14.1–22.1%, 90th percentile 22.4%17.2CVS Health / Aetna · Aetna Better Health of New Jersey — 27.6%CVS Health / Aetna · Aetna Better Health of Maryland — 23.2%Medicare-Medicaid Plan3 filingsCVS Health / Aetna · Aetna Better Health Premier Plan (Medicare-Medicaid) — 6.6%CVS Health / Aetna · Aetna Better Health Premier Plan Michigan — 5.9%CVS Health / Aetna · Aetna MyCare Ohio — 3.6%CHIP Managed Care1 filingCVS Health / Aetna · Aetna Better Health Kids (Pennsylvania CHIP) — 18.0%
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 → 28.5% of denials10% of plans → 28% 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
■ 15 publish counts ▨ 39 publish no counts — a rate nobody can check ● 2 carry validation findings

Filings

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Denial rate Volume Organization Findings
Organization
Plan
Market
St
Std reqs
Denial rate
Findings
CVS Health / Aetna Aetna Better Health of New Jersey Medicaid Managed Care NJ 56K 27.6% — CVS Health / Aetna Aetna Better Health of Maryland Medicaid Managed Care MD 16K 23.2% — CVS Health / Aetna Aetna Better Health of Florida Medicaid Managed Care FL 43K 22.4% — CVS Health / Aetna Aetna Better Health of Michigan Medicaid Managed Care MI 18K 22.1% — CVS Health / Aetna Aetna Better Health of Kentucky Medicaid Managed Care KY 123K 19.5% — CVS Health / Aetna Aetna Better Health of West Virginia Medicaid Managed Care WV 83K 19.3% — CVS Health / Aetna Aetna Better Health Kids (Pennsylvania CHIP) CHIP Managed Care PA 2K 18.0% 2 CVS Health / Aetna Aetna Better Health of Virginia Medicaid Managed Care VA 108K 17.2% — CVS Health / Aetna Aetna Medicare Advantage - contract H5309 Medicare Advantage — — 16.3% — CVS Health / Aetna Aetna Better Health of Illinois Medicaid Managed Care IL 111K 15.6% — CVS Health / Aetna Aetna Better Health of Louisiana Medicaid Managed Care LA 80K 15.2% — CVS Health / Aetna Aetna Better Health of Ohio (OhioRISE) Medicaid Managed Care OH 76K 14.1% — CVS Health / Aetna Aetna Medicare Advantage - contract H8332 Medicare Advantage — — 13.2% — CVS Health / Aetna Aetna Medicare Advantage - contract H4523 Medicare Advantage — — 12.7% — CVS Health / Aetna Aetna Medicare Advantage - contract H3219 Medicare Advantage — — 11.5% — CVS Health / Aetna Aetna Medicare Advantage - contract H4711 Medicare Advantage — — 11.3% — CVS Health / Aetna Aetna Medicare Advantage - contract H3288 Medicare Advantage — — 10.9% — CVS Health / Aetna Aetna Better Health of Oklahoma Medicaid Managed Care OK 64K 10.8% — CVS Health / Aetna Aetna Medicare Advantage - contract H4835 Medicare Advantage — — 10.7% — CVS Health / Aetna Aetna Medicare Advantage - contract H3928 Medicare Advantage — — 10.4% — CVS Health / Aetna Aetna Medicare Advantage - contract H3239 Medicare Advantage — — 10.4% — CVS Health / Aetna Aetna Medicare Advantage - contract H1609 Medicare Advantage — — 10.4% — CVS Health / Aetna Aetna Better Health of New York Medicaid Managed Care NY 53K 10.0% — CVS Health / Aetna Aetna Medicare Advantage - contract H1692 Medicare Advantage — — 9.6% — CVS Health / Aetna Aetna Medicare Advantage - contract H3931 Medicare Advantage — — 9.5% — CVS Health / Aetna Aetna Medicare Advantage - contract H5325 Medicare Advantage — — 8.7% — CVS Health / Aetna Aetna Medicare Advantage - contract H2293 Medicare Advantage — — 8.3% — CVS Health / Aetna Aetna Medicare Advantage - contract H1608 Medicare Advantage — — 8.2% — CVS Health / Aetna Aetna Medicare Advantage - contract H5521 Medicare Advantage — — 7.9% — CVS Health / Aetna Aetna Medicare Advantage - contract H7149 Medicare Advantage — — 7.8% — 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% — CVS Health / Aetna Aetna Medicare Advantage - contract H5302 Medicare Advantage — — 7.4% — CVS Health / Aetna Aetna Medicare Advantage - contract H3312 Medicare Advantage — — 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% — CVS Health / Aetna Aetna Medicare Advantage - contract H2056 Medicare Advantage — — 7.2% — CVS Health / Aetna Aetna Medicare Advantage - contract H3146 Medicare Advantage — — 7.1% — CVS Health / Aetna Aetna Medicare Advantage - contract H5593 Medicare Advantage — — 7.0% — CVS Health / Aetna Aetna Medicare Advantage - contract H5522 Medicare Advantage — — 7.0% — CVS Health / Aetna Aetna Medicare Advantage - contract H2663 Medicare Advantage — — 6.8% — 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% — CVS Health / Aetna Aetna Medicare Advantage - contract H3959 Medicare Advantage — — 6.1% — CVS Health / Aetna Aetna Medicare Advantage - contract H7301 Medicare Advantage — — 6.0% — CVS Health / Aetna Aetna Medicare Advantage - contract H1206 Medicare Advantage — — 6.0% — CVS Health / Aetna Aetna Better Health Premier Plan Michigan Medicare-Medicaid Plan MI — 5.9% — CVS Health / Aetna Aetna Medicare Advantage - contract H5793 Medicare Advantage — — 5.8% — CVS Health / Aetna Aetna Medicare Advantage - contract H3597 Medicare Advantage — — 5.5% — CVS Health / Aetna Aetna MyCare Ohio Medicare-Medicaid Plan OH 61K 3.6% — CVS Health / Aetna Aetna Medicare Advantage - contract H0523 Medicare Advantage — — 2.4% — CVS Health / Aetna Aetna Medicare Advantage - contract H4982 Medicare Advantage — — 2.0% — CVS Health / Aetna Aetna Medicare Advantage - contract H0562 Medicare Advantage — — 0.0% 1