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
16 of 536
filings in view
879K
standard requests
4.2%
volume-weighted denial rate
3
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
13
3
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
1K10K100K500K
Request volume by market, current filter
Medicare Advantage 703K 8 filings
Marketplace QHP 121K 4 filings
Medicaid Managed Care 56K 4 filings

Filings

Download CSV · JSON
Sort
Denial rate Volume Organization Findings
Organization
Plan
Market
St
Std reqs
Denial rate
Findings
Highmark Highmark Medicare Advantage contract H7710 Medicare Advantage DE 671 12.4% — Highmark Highmark Medicare Advantage contract H5932 Medicare Advantage PA 7K 12.2% 1 Highmark Highmark QHP (federal Marketplace) - West Virginia Marketplace QHP WV 25K 11.8% 1 Highmark Highmark Medicaid - New York Medicaid Managed Care NY — 8.7% — Highmark Highmark QHP (federal Marketplace) - Delaware Marketplace QHP DE 16K 8.3% — Highmark Highmark QHP (federal Marketplace) - Pennsylvania Marketplace QHP PA 78K 6.1% 1 Highmark Highmark Medicare Advantage contract H5106 Medicare Advantage — 41K 5.2% — Highmark Highmark Medicare Advantage contract H8166 Medicare Advantage — 27K 4.1% — 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% — Highmark Highmark QHP (federal Marketplace) - New York Marketplace QHP NY 1K 3.4% — Highmark Highmark Medicare Advantage contract H3957 Medicare Advantage — 98K 3.3% — 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% —