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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13 of 658
filings in view
115K
standard requests
11.0%
volume-weighted denial rate
0
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
7
4
1
1
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 71K 5 filings
Medicare-Medicaid Plan 30K 3 filings
Medicare Advantage 13K 4 filings
Medicaid FFS 0 1 filings
Where the denial rate is highest
volume-weighted per state · floor 10K requests · top 10 · click a state for its filings
MA 11.0% 115K · 10 filings
Organizations by denials in view
standard denials summed over the slice · weighted rate beside each · top 10
Mass General Brigham 6K 10.5%
UnitedHealth Group 5K 22.5%
Fallon Health 1K 6.8%
Point32Health 1K 4.9%
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 Care5 filingsMedicaid Managed Care: median 6.8%, middle half 5.2–7.4%, 90th percentile 7.4%6.8Mass General Brigham · Mass General Brigham Health Plan - MGB ACO (MassHealth) — 10.1%Medicare Advantage4 filingsMass General Brigham · Mass General Brigham Advantage PPO — 11.7%Mass General Brigham · Mass General Brigham Advantage Secure HMO-POS — 11.0%Blue Cross Blue Shield of Massachusetts · BCBSMA Medicare Advantage HMO — 4.6%Blue Cross Blue Shield of Massachusetts · BCBSMA Medicare Advantage PPO — 4.4%Medicare-Medicaid Plan3 filingsUnitedHealth Group · Massachusetts Senior Care Options — 33.3%UnitedHealth Group · Massachusetts One Care — 22.4%Point32Health · Tufts Health One Care — 4.5%Medicaid FFS1 filingCommonwealth of Massachusetts · Calendar Year 2025 Prior Authorization Metrics (program not named in document) — 14.6%
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 → 35.9% of denials10% of plans → 36% 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
■ 10 publish counts ▨ 3 publish no counts — a rate nobody can check ● 0 carry validation findings

Filings

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Denial rate Volume Organization Findings
Organization
Plan
Market
St
Std reqs
Denial rate
Findings
UnitedHealth Group Massachusetts Senior Care Options Medicare-Medicaid Plan MA 84 33.3% — UnitedHealth Group Massachusetts One Care Medicare-Medicaid Plan MA 20K 22.4% — Commonwealth of Massachusetts Calendar Year 2025 Prior Authorization Metrics (program not named in document) Medicaid FFS MA — 14.6% — Mass General Brigham Mass General Brigham Advantage PPO Medicare Advantage MA 11K 11.7% — Mass General Brigham Mass General Brigham Advantage Secure HMO-POS Medicare Advantage MA 2K 11.0% — Mass General Brigham Mass General Brigham Health Plan - MGB ACO (MassHealth) Medicaid Managed Care MA 41K 10.1% — Point32Health Tufts Health Together Managed Care Organization (MCO) Medicaid Managed Care MA 2K 7.4% — Fallon Health Fallon Health – Atrius Health Care Collaborative (365 Care) Medicaid Managed Care MA 18K 6.8% — Point32Health Tufts Health Together with UMass Memorial Health Medicaid Managed Care MA 6K 5.2% — Blue Cross Blue Shield of Massachusetts BCBSMA Medicare Advantage HMO Medicare Advantage MA — 4.6% — Point32Health Tufts Health One Care Medicare-Medicaid Plan MA 10K 4.5% — Blue Cross Blue Shield of Massachusetts BCBSMA Medicare Advantage PPO Medicare Advantage MA — 4.4% — Point32Health Tufts Health Together with Cambridge Health Alliance (CHA) Medicaid Managed Care MA 4K 4.0% —