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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28 of 658
filings in view
1.6M
standard requests
12.0%
volume-weighted denial rate
28
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
14
12
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
Medicaid Managed Care 763K 12 filings
Medicaid FFS 455K 6 filings
Medicare Advantage 367K 5 filings
Unclassified 7K 2 filings
Marketplace QHP 3K 2 filings
CHIP Managed Care 1K 1 filings
Where the denial rate is highest
volume-weighted per state · floor 10K requests · top 10 · click a state for its filings
SC 18.3% 72K · 1 filing
PA 16.8% 626K · 2 filings
NH 15.0% 57K · 3 filings
NC 15.0% 78K · 1 filing
CA 10.9% 62K · 1 filing
LA 10.7% 87K · 1 filing
WY 10.3% 21K · 2 filings
MS 10.2% 60K · 1 filing
OR 7.7% 50K · 2 filings
TX 5.1% 46K · 6 filings
Organizations by denials in view
standard denials summed over the slice · weighted rate beside each · top 10
AmeriHealth Caritas 111K 23.0%
AmeriHealth Caritas Family of Companies 17K 18.3%
Geisinger Health 16K 5.1%
Indiana Family and Social Services Administration 10K 5.1%
Contra Costa Health 7K 10.9%
Wisconsin Department of Health Services 7K 4.0%
Mississippi Division of Medicaid 6K 10.2%
Centene 5K 13.4%
CareOregon 4K 7.7%
Sentara Health 3K 5.1%
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%Medicaid Managed Care12 filingsMedicaid Managed Care: median 10.8%, middle half 7.2–15.0%, 90th percentile 18.3%10.8AmeriHealth Caritas · Keystone First — 28.4%AmeriHealth Caritas Family of Companies · AmeriHealth Caritas New Hampshire — 18.8%Medicaid FFS6 filingsMedicaid FFS: median 5.2%, middle half 5.1–10.2%, 90th percentile 10.3%5.2Medicare Advantage5 filingsMedicare Advantage: median 5.1%, middle half 5.1–9.0%, 90th percentile 9.0%5.1AmeriHealth Caritas Family of Companies · AmeriHealth Caritas VIP Care (Michigan) — 16.4%Unclassified2 filingsSanford Health Plan · Sanford Health Plan — 22.4%Sanford Health Plan · Sanford Health Plan — 16.5%Marketplace QHP2 filingsPoint32Health · Harvard Pilgrim Health Care – New Hampshire Exchange Local Choice — 15.9%Community First Health Plans · University Community Care Plan (Marketplace) — 2.8%CHIP Managed Care1 filingCommunity First Health Plans · Community First CHIP — 4.6%
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 → 61.9% of denials10% of plans → 62% 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
■ 28 publish counts ▨ 0 publish no counts — a rate nobody can check ● 28 carry validation findings

Filings

This view as JSON
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Denial rate Volume Organization Findings
Organization
Plan
Market
St
Std reqs
Denial rate
Findings
AmeriHealth Caritas Keystone First Medicaid Managed Care PA 315K 28.4% 1 Sanford Health Plan Sanford Health Plan Unclassified — 4K 22.4% 1 AmeriHealth Caritas Family of Companies AmeriHealth Caritas New Hampshire Medicaid Managed Care NH 17K 18.8% 2 AmeriHealth Caritas Family of Companies First Choice by Select Health of South Carolina Medicaid Managed Care SC 72K 18.3% 1 Sanford Health Plan Sanford Health Plan Unclassified — 3K 16.5% 1 AmeriHealth Caritas Family of Companies AmeriHealth Caritas VIP Care (Michigan) Medicare Advantage MI 6K 16.4% 1 Point32Health Harvard Pilgrim Health Care – New Hampshire Exchange Local Choice Marketplace QHP NH 182 15.9% 1 AmeriHealth Caritas AmeriHealth Caritas North Carolina Medicaid Managed Care NC 78K 15.0% 2 Centene NH Healthy Families Medicaid Managed Care NH 40K 13.4% 1 Contra Costa Health Contra Costa Health Plan (Medi-Cal) Medicaid Managed Care CA 62K 10.9% 2 AmeriHealth Caritas AmeriHealth Caritas Louisiana Medicaid Managed Care LA 87K 10.8% 2 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 Mississippi Division of Medicaid Mississippi Medicaid Fee-for-Service Medicaid FFS MS 60K 10.2% 2 CHRISTUS Health Plan CHRISTUS Health Plan Medicare Advantage — 399 9.0% 1 CareOregon Columbia Pacific CCO Medicaid Managed Care OR 16K 7.9% 2 CareOregon Jackson Care Connect Medicaid Managed Care OR 35K 7.6% 2 Community First Health Plans Community First Texas Medicaid STAR+PLUS Medicaid Managed Care TX 9K 7.2% 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 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 Sentara Health Sentara Health Plans - Medicare Medicare Advantage VA 50K 5.1% 1 Community First Health Plans Community First Texas Medicaid STAR Medicaid Managed Care TX 20K 4.7% 2 Community First Health Plans Community First CHIP CHIP Managed Care TX 1K 4.6% 1 Wisconsin Department of Health Services Wisconsin Medicaid (ForwardHealth) -- specific program/agency not named in document Medicaid FFS WI 165K 4.0% 2 Community First Health Plans University Community Care Plan (Marketplace) Marketplace QHP TX 3K 2.8% 2 Community First Health Plans Community First Medicare Advantage (Alamo & D-SNP) Medicare Advantage TX 508 2.6% 2