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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15 of 658
filings in view
415K
standard requests
8.2%
volume-weighted denial rate
1
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
6
9
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 FFS 165K 1 filings
Medicare Advantage 128K 3 filings
Medicaid Managed Care 110K 8 filings
Marketplace QHP 12K 3 filings
Where the denial rate is highest
volume-weighted per state · floor 10K requests · top 10 · click a state for its filings
WI 8.2% 415K · 11 filings
Organizations by denials in view
standard denials summed over the slice · weighted rate beside each · top 10
Network Health (Wisconsin) 17K 12.4%
Wisconsin Department of Health Services 7K 4.0%
UnitedHealth Group 6K 7.8%
Humana / iCare 3K 13.0%
Centene 2K 15.0%
HealthPartners 161 13.7%
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 Care8 filingsMedicaid Managed Care: median 10.0%, middle half 7.0–13.3%, 90th percentile 15.0%10.0Humana / iCare · iCare BadgerCare Plus — 15.0%Medicare Advantage3 filingsNetwork Health (Wisconsin) · Network Health MSA Network Prime — 17.5%Network Health (Wisconsin) · Network Health Medicare Advantage — 12.2%Humana / iCare · iCare Medicare Plan — 9.7%Marketplace QHP3 filingsNetwork Health (Wisconsin) · Network Health ACA/exchange plans — 13.9%HealthPartners · HealthPartners Commercial Wisconsin Federally Facilitated Exchange (on-exchange QHP) plans — 13.7%Group Health Cooperative of South Central Wisconsin · GHC-SCW Qualified Health Plan (Marketplace) — 3.0%Medicaid FFS1 filingWisconsin Department of Health Services · Wisconsin Medicaid (ForwardHealth) -- specific program/agency not named in document — 4.0%
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 → 43.9% of denials10% of plans → 44% 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
■ 11 publish counts ▨ 4 publish no counts — a rate nobody can check ● 1 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
Network Health (Wisconsin) Network Health MSA Network Prime Medicare Advantage WI 790 17.5% — Humana / iCare iCare BadgerCare Plus Medicaid Managed Care WI 8K 15.0% — Centene MHS Health Wisconsin (NHP line) Medicaid Managed Care WI 11K 15.0% — Network Health (Wisconsin) Network Health ACA/exchange plans Marketplace QHP WI 11K 13.9% — HealthPartners HealthPartners Commercial Wisconsin Federally Facilitated Exchange (on-exchange QHP) plans Marketplace QHP WI 1K 13.7% — Humana / iCare iCare Medicaid SSI Medicaid Managed Care WI 6K 13.3% — Network Health (Wisconsin) Network Health Medicare Advantage Medicare Advantage WI 123K 12.2% — Humana / iCare iCare Family Care Partnership Medicaid Managed Care WI 3K 11.3% — Molina Healthcare Molina Healthcare of Wisconsin - BadgerCare Plus Medicaid Managed Care WI — 10.0% — Humana / iCare iCare Medicare Plan Medicare Advantage WI 4K 9.7% — UnitedHealth Group Wisconsin Medicaid Medicaid Managed Care WI 81K 7.8% — Molina Healthcare Molina Healthcare of Wisconsin - Medicaid SSI Medicaid Managed Care WI — 7.0% — Wisconsin Department of Health Services Wisconsin Medicaid (ForwardHealth) -- specific program/agency not named in document Medicaid FFS WI 165K 4.0% 2 Group Health Cooperative of South Central Wisconsin GHC-SCW Qualified Health Plan (Marketplace) Marketplace QHP WI — 3.0% — Group Health Cooperative of South Central Wisconsin GHC-SCW BadgerCare Plus (WI Medicaid) Medicaid Managed Care WI — 2.0% —