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
884K
standard requests
17.5%
volume-weighted denial rate
13
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
18
10
1
2
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 422K 13 filings
Marketplace QHP 313K 6 filings
Multiple (combined) 128K 1 filings
Medicare Advantage 16K 3 filings
CHIP Managed Care 5K 8 filings
Medicare-Medicaid Plan 240 1 filings
Where the denial rate is highest
volume-weighted per state · floor 10K requests · top 10 · click a state for its filings
TX 17.5% 884K · 20 filings
Organizations by denials in view
standard denials summed over the slice · weighted rate beside each · top 10
Centene 104K 32.2%
UnitedHealth Group 26K 9.2%
Texas Children's Health Plan 13K 9.9%
Community Health Choice 7K 11.7%
CVS Health / Aetna 3K 7.7%
Community First Health Plans 2K 5.1%
CHRISTUS Health 136 4.8%
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 Care13 filingsMedicaid Managed Care: median 7.7%, middle half 5.4–16.0%, 90th percentile 17.0%7.7Driscoll Health Plan · Driscoll Health Plan STAR Kids — 18.0%CHIP Managed Care8 filingsCHIP Managed Care: median 9.0%, middle half 4.6–15.0%, 90th percentile 16.6%9.0Molina Healthcare · Molina Healthcare of Texas CHIP Medicaid — 17.0%Marketplace QHP6 filingsMarketplace QHP: median 4.8%, middle half 2.8–22.7%, 90th percentile 32.5%4.8Centene · Ambetter from Superior HealthPlan (29418) — 32.9%Medicare Advantage3 filingsCentene · Wellcare by Superior HealthPlan H7323 — 19.2%Community Health Choice · Community Health Choice D-SNP — 8.8%Community First Health Plans · Community First Medicare Advantage (Alamo & D-SNP) — 2.6%Medicare-Medicaid Plan1 filingUnitedHealth Group · Texas MMP — 40.4%Multiple (combined)1 filingTexas Children's Health Plan · Texas Children's Health Plan (STAR/CHIP/STAR Kids combined) — 9.9%
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 → 65.1% of denials10% of plans → 65% 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
■ 21 publish counts ▨ 11 publish no counts — a rate nobody can check ● 13 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
UnitedHealth Group Texas MMP Medicare-Medicaid Plan TX 240 40.4% 1 Centene Ambetter from Superior HealthPlan (29418) Marketplace QHP TX 218K 32.9% 1 Centene Ambetter from Superior HealthPlan (87226) Marketplace QHP TX 90K 32.5% 1 Oscar Health Oscar Health - Texas Marketplace QHP TX — 22.7% — Centene Wellcare by Superior HealthPlan H7323 Medicare Advantage TX 14K 19.2% — Driscoll Health Plan Driscoll Health Plan STAR Kids Medicaid Managed Care TX — 18.0% — Driscoll Health Plan Driscoll Health Plan STAR Medicaid Managed Care TX — 17.0% — Molina Healthcare Molina Healthcare of Texas CHIP Medicaid CHIP Managed Care TX — 17.0% — Molina Healthcare Molina Healthcare of Texas STAR Medicaid Managed Care TX — 17.0% — Community Health Choice Community Health Choice CHIP & CHIP Perinatal (combined) CHIP Managed Care TX 3K 16.6% 1 UnitedHealth Group Texas STAR Medicaid Managed Care TX 139K 16.0% — Molina Healthcare Molina Healthcare of Texas CHIP RSA Medicaid CHIP Managed Care TX — 15.0% — Community Health Choice Community Health Choice STAR & STAR+PLUS (combined) Medicaid Managed Care TX 52K 11.5% 1 Driscoll Health Plan Driscoll Health Plan CHIP CHIP Managed Care TX — 11.0% — Texas Children's Health Plan Texas Children's Health Plan (STAR/CHIP/STAR Kids combined) Multiple (combined) TX 128K 9.9% — UnitedHealth Group Texas CHIP CHIP Managed Care TX 577 9.0% — Community Health Choice Community Health Choice D-SNP Medicare Advantage TX 1K 8.8% — Elevance Health Wellpoint Texas Medicaid & CHIP (all) Medicaid Managed Care TX — 8.6% — CVS Health / Aetna Aetna Better Health of Texas Medicaid Managed Care TX 41K 7.7% — Community First Health Plans Community First Texas Medicaid STAR+PLUS Medicaid Managed Care TX 9K 7.2% 2 Molina Healthcare Molina Healthcare of Texas STAR+PLUS Medicaid Managed Care TX — 6.0% — UnitedHealth Group Texas STAR Kids Medicaid Managed Care TX 18K 5.4% — Community First Health Plans Community First Texas Medicaid STAR Kids Medicaid Managed Care TX 12K 5.2% 1 Molina Healthcare Molina Healthcare of Texas CHIP Perinate RSA (at or below 185% FPL) CHIP Managed Care TX — 5.0% 1 CHRISTUS Health CHRISTUS Health Plan (TX Marketplace) Marketplace QHP TX 3K 4.8% — 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 Molina Healthcare Molina Healthcare of Texas CHIP Perinate MHT (at or below 185% FPL) CHIP Managed Care TX — 4.0% 1 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 UnitedHealth Group UnitedHealthcare Community Plan - Texas STAR+PLUS Medicaid Managed Care TX 130K 2.3% — Sendero Health Plans Sendero Health Plans (IdealCare marketplace) Marketplace QHP TX — 2.2% —