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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62 of 658
filings in view
2.8M
standard requests
13.4%
volume-weighted denial rate
9
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
21
29
8
1
1
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 1.4M 30 filings
Medicare Advantage 1.3M 22 filings
CHIP Managed Care 57K 9 filings
Marketplace QHP 1K 1 filings
Where the denial rate is highest
volume-weighted per state · floor 10K requests · top 10 · click a state for its filings
NY 13.3% 2.8M · 47 filings
Organizations by denials in view
standard denials summed over the slice · weighted rate beside each · top 10
Healthfirst 240K 13.6%
Excellus BlueCross BlueShield 37K 9.6%
EmblemHealth 33K 16.7%
Independent Health 22K 13.4%
UnitedHealth Group 21K 20.8%
MetroPlus Health Plan 12K 15.3%
CVS Health / Aetna 5K 10.0%
CDPHP 4K 11.9%
Univera Healthcare 3K 6.6%
Highmark 46 3.4%
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 Care30 filingsMedicaid Managed Care: median 15.3%, middle half 12.3–19.7%, 90th percentile 28.6%15.3VillageCare · VillageCareMAX Managed Long-Term Care — 62.3%Hamaspik · Hamaspik Medicare Choice (MAP - Medicaid side) — 52.0%Hamaspik · Hamaspik Choice (MLTC) — 49.0%Medicare Advantage22 filingsMedicare Advantage: median 10.0%, middle half 7.7–12.0%, 90th percentile 17.8%10.0Univera Healthcare · Univera Healthcare Medicare D-SNP (HMO) — 36.4%Excellus BlueCross BlueShield · Excellus BCBS Medicare D-SNP (HMO) — 29.3%Hamaspik · Hamaspik Medicare Select (H0034 D-SNP & MAP Medicare, combined) — 26.0%CHIP Managed Care9 filingsCHIP Managed Care: median 14.5%, middle half 11.6–18.0%, 90th percentile 26.5%14.5Healthfirst · Child Health Plus — 28.3%Marketplace QHP1 filingHighmark · Highmark QHP (federal Marketplace) - New York — 3.4%
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 → 72.3% of denials10% of plans → 72% 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
■ 47 publish counts ▨ 15 publish no counts — a rate nobody can check ● 9 carry validation findings

Filings

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Denial rate Volume Organization Findings
Organization
Plan
Market
St
Std reqs
Denial rate
Findings
VillageCare VillageCareMAX Managed Long-Term Care Medicaid Managed Care NY — 62.3% 1 Hamaspik Hamaspik Medicare Choice (MAP - Medicaid side) Medicaid Managed Care NY — 52.0% 1 Hamaspik Hamaspik Choice (MLTC) Medicaid Managed Care NY — 49.0% 1 Univera Healthcare Univera Healthcare Medicare D-SNP (HMO) Medicare Advantage NY 118 36.4% — Excellus BlueCross BlueShield Excellus BCBS Medicare D-SNP (HMO) Medicare Advantage NY 2K 29.3% — VillageCare VillageCareMAX Total Advantage (D-SNP) - Medicaid requests Medicaid Managed Care NY — 28.6% — Healthfirst Child Health Plus CHIP Managed Care NY 28K 28.3% — Independent Health Independent Health Medicaid, Essential and CHP (combined) Medicaid Managed Care NY 36K 28.2% — UnitedHealth Group New York Child Health Plus CHIP Managed Care NY 2K 26.5% 1 Hamaspik Hamaspik Medicare Select (H0034 D-SNP & MAP Medicare, combined) Medicare Advantage NY — 26.0% — EmblemHealth EmblemHealth Medicaid and HARP (combined) Medicaid Managed Care NY 115K 22.5% — UnitedHealth Group New York Medicaid Advantage Medicaid Managed Care NY 76K 22.4% — MetroPlus Health Plan MetroPlus Managed Long Term Care Medicaid Managed Care NY 4K 19.8% — Healthfirst Medicaid Managed Care Medicaid Managed Care NY 751K 19.7% — MetroPlus Health Plan MetroPlus HARP Medicaid Managed Care NY 6K 19.0% — CDPHP CDPHP Child Health Plus CHIP Managed Care NY 455 18.0% — EmblemHealth EmblemHealth Child Health Plus CHIP Managed Care NY 6K 17.9% — VillageCare VillageCareMAX Medicare (all plans, aggregated) Medicare Advantage NY — 17.8% — UnitedHealth Group New York Essential Plan Program Medicaid Managed Care NY 19K 16.7% — Molina Healthcare Molina Healthcare of New York Medicaid Medicaid Managed Care NY — 16.0% — Univera Healthcare Univera Healthcare MyHealth (MMC) Medicaid Managed Care NY 5K 16.0% — MetroPlus Health Plan MetroPlus Partnership in Care (HIV SNP) Medicaid Managed Care NY 2K 15.7% — MetroPlus Health Plan MetroPlus Medicaid Managed Care Medicaid Managed Care NY 52K 15.4% — Healthfirst Health and Recovery Plan (HARP) Medicaid Managed Care NY 54K 15.3% — Excellus BlueCross BlueShield Excellus BCBS Managed Medicaid (MMC) Medicaid Managed Care NY 126K 15.0% — Excellus BlueCross BlueShield Excellus BCBS Child Health Plus CHIP Managed Care NY 18K 14.5% — EmblemHealth EmblemHealth Medicare H5991 Medicare Advantage NY 5K 14.0% — MetroPlus Health Plan MetroPlus Child Health Plus CHIP Managed Care NY 2K 13.8% — EmblemHealth EmblemHealth Medicare H5228 Medicare Advantage NY 29 13.8% — Univera Healthcare Univera Healthcare MyHealth Plus (HARP) Medicaid Managed Care NY 498 13.1% — Molina Healthcare Senior Whole Health of New York - MLTSS Medicaid Managed Care NY — 13.0% 1 CDPHP CDPHP Medicaid HARP Medicaid Managed Care NY 2K 13.0% — Excellus BlueCross BlueShield Excellus BCBS Blue Option Plus (HARP) Medicaid Managed Care NY 18K 12.9% — Healthfirst MLTC Medicaid Managed Care NY 30K 12.8% — CDPHP CDPHP Managed Medicaid Medicaid Managed Care NY 8K 12.3% — MetroPlus Health Plan MetroPlus Medicare (H0423) Medicare Advantage NY 10K 12.0% — CDPHP CDPHP Medicare HMO Medicare Advantage NY 19K 11.9% — Elevance Health Anthem HealthPlus New York Child Health Plus CHIP Managed Care NY — 11.6% — Independent Health Independent Health Medicare H3344 Medicare Advantage NY 7K 11.2% — Healthfirst Contract H9678 Medicare Advantage NY 11K 10.3% — CDPHP CDPHP Medicare PPO Medicare Advantage NY 4K 10.0% — CVS Health / Aetna Aetna Better Health of New York Medicaid Managed Care NY 53K 10.0% — Healthfirst Contract H5989 Medicare Advantage NY 52K 10.0% — Healthfirst Contract H1722 Medicare Advantage NY 3K 9.6% 1 UnitedHealth Group New York Wellness 4Me (HARP) Medicaid Managed Care NY 4K 9.0% 1 Independent Health Independent Health Medicare H3362 Medicare Advantage NY 117K 9.0% — Highmark Highmark Medicaid - New York Medicaid Managed Care NY — 8.7% — Healthfirst Contract H3359 Medicare Advantage NY 764K 8.2% — Molina Healthcare Senior Whole Health of New York - Medicare Medicare Advantage NY — 8.0% — EmblemHealth EmblemHealth Medicare H3330 Medicare Advantage NY 73K 7.7% — Univera Healthcare Univera Healthcare Child Health Plus CHIP Managed Care NY 215 6.5% — MetroPlus Health Plan MetroPlus Medicaid Advantage Plus Medicaid Managed Care NY 1K 6.4% 1 Univera Healthcare Univera Healthcare Medicare PPO Medicare Advantage NY 3K 6.2% — Excellus BlueCross BlueShield Excellus BCBS Medicare PPO Medicare Advantage NY 118K 6.2% — MJHS Health System Elderplan Medicare Advantage NY — 6.0% — Univera Healthcare Univera Healthcare Medicare HMO Medicare Advantage NY 33K 5.0% — Molina Healthcare Molina Healthcare of New York Child Health Plus CHIP Managed Care NY — 5.0% — Excellus BlueCross BlueShield Excellus BCBS Medicare HMO Medicare Advantage NY 103K 4.9% — Highmark Highmark QHP (federal Marketplace) - New York Marketplace QHP NY 1K 3.4% — Healthfirst Medicaid Only Services for Medicaid Advantage Plus Medicaid Managed Care NY 71K 3.2% — Elevance Health Anthem HealthPlus New York Medicaid Medicaid Managed Care NY — 1.2% — Molina Healthcare Senior Whole Health of New York - FIDE Medicaid Managed Care NY — 0.0% 1