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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32 of 658
filings in view
17.6M
standard requests
8.4%
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 · click a bar for its filings
22
5
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 9.7M 16 filings
Medicaid FFS 4.1M 4 filings
Marketplace QHP 2.8M 3 filings
Medicare Advantage 1.0M 9 filings
Where the denial rate is highest
volume-weighted per state · floor 10K requests · top 10 · click a state for its filings
CA 8.4% 17.6M · 30 filings
Organizations by denials in view
standard denials summed over the slice · weighted rate beside each · top 10
California DHCS 1.1M 28.9%
Centene 109K 2.8%
Kaiser Permanente 57K 12.9%
L.A. Care Health Plan 43K 1.8%
Inland Empire Health Plan 42K 1.2%
California Department of Health Care Services 22K 28.4%
CalOptima Health 18K 1.7%
Santa Clara Family Health Plan 9K 4.4%
Central California Alliance for Health 8K 1.5%
Contra Costa Health 7K 10.9%
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 Care15 filingsMedicaid Managed Care: median 2.5%, middle half 1.7–6.3%, 90th percentile 7.6%2.5Contra Costa Health · Contra Costa Health Plan (Medi-Cal) — 10.9%Kaiser Permanente · Kaiser Permanente Northern California - Medi-Cal — 9.0%Medicare Advantage9 filingsMedicare Advantage: median 9.1%, middle half 2.0–11.0%, 90th percentile 11.3%9.1Kaiser Permanente · Kaiser Permanente Southern California — 19.5%Medicaid FFS4 filingsCalifornia 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%California DHCS · California Children's Services (CCS) — 26.5%Marketplace QHP3 filingsInland Empire Health Plan · IEHP Covered California — 2.1%L.A. Care Health Plan · L.A. Care Medi-Cal — 1.9%L.A. Care Health Plan · L.A. Care Medicare Plus (HMO D-SNP) — 1.0%
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 → 81.2% of denials10% of plans → 81% 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
■ 31 publish counts ▨ 1 publish no counts — a rate nobody can check ● 3 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
California DHCS Medi-Cal Dental Fee-for-Service Medicaid FFS CA 3.1M 29.5% — 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 California DHCS California Children's Services (CCS) Medicaid FFS CA 756K 26.5% — Kaiser Permanente Kaiser Permanente Southern California Medicare Advantage CA 144K 19.5% — Kaiser Permanente Kaiser Permanente Northern California (H8794) Medicare Advantage CA 40K 11.3% — Kaiser Permanente Kaiser Permanente Southern California (H8794) Medicare Advantage CA 34K 11.0% — Contra Costa Health Contra Costa Health Plan (Medi-Cal) Medicaid Managed Care CA 62K 10.9% 2 Kaiser Permanente Kaiser Permanente Northern California Medicare Advantage CA 145K 10.5% — Santa Clara Family Health Plan SCFHP DualConnect (HMO D-SNP) Medicare Advantage CA 13K 9.1% — Kaiser Permanente Kaiser Permanente Northern California - Medi-Cal Medicaid Managed Care CA 25K 9.0% — Centene Community Health Plan of Imperial Valley Medi-Cal Medicaid Managed Care CA 57K 7.6% — Kaiser Permanente Kaiser Permanente Southern California - Medi-Cal Medicaid Managed Care CA 57K 6.4% — Centene CalViva Health Medi-Cal Medicaid Managed Care CA 310K 6.3% — Santa Clara Family Health Plan SCFHP Medi-Cal Medicaid Managed Care CA 182K 4.0% — Alameda Alliance for Health Alameda Alliance for Health Medicaid Managed Care CA 117K 3.0% — Centene Health Net Medi-Cal Medicaid Managed Care CA 3.1M 2.5% — Inland Empire Health Plan IEHP Covered California Marketplace QHP CA 379K 2.1% — Inland Empire Health Plan IEHP DualChoice (HMO D-SNP) Medicare Advantage CA 93K 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% — 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% — CalOptima Health CalOptima Health OneCare (HMO D-SNP) Medicare Advantage CA 95K 1.4% — Inland Empire Health Plan IEHP Medi-Cal Medicaid Managed Care CA 3.0M 1.1% — L.A. Care Health Plan L.A. Care Medicare Plus (HMO D-SNP) Marketplace QHP CA 284K 1.0% — Blue Shield of California Blue Shield of California Promise Health Plan (Medi-Cal) Medicaid Managed Care CA 892K 0.7% — Health Plan of San Mateo Health Plan of San Mateo Medicaid Managed Care CA 9K — —