Crossfoot
03 · Validation

Every filing checked against itself

CMS mandates publication. It does not mandate a format, does not require counts, and does not check arithmetic. 10 rules do.

All rules error warn info
Rule
Severity
Hits
Catches
std_counts_reconcile error 19 approved + denied ≠ stated total exp_counts_reconcile error 13 same, expedited appeals_exceed_total error 1 more overturns than appeals filed expedited_slower_than_standard warn 20 expedited turnaround exceeding standard high_denial_rate warn 11 rates far outside the peer range expedited_exceeds_standard_volume warn 10 transposed standard/expedited columns zero_denial_rate warn 7 0% denial reported std_headline_excludes_extended warn 1 extended-review cases outside the headline appeals_not_reported info 139 no appeal outcome published percentages_only info 119 no counts, so arithmetic cannot be checked
23
of 536 filings publish numbers that do not reconcile against themselves
119
publish percentages with no counts at all
139
publish no appeal outcome
340
total findings across 536 filings

appeals_not_reported · 139 hits

no appeal outcome published Show all 340
Plan
Severity
Rule
Detail
Senior Whole Health of New York - FIDE
Molina Healthcare · NY info appeals_not_reported no appeal outcome data published Senior Whole Health of New York - MLTSS
Molina Healthcare · NY info appeals_not_reported no appeal outcome data published Senior Whole Health of New York - Medicare
Molina Healthcare · NY info appeals_not_reported no appeal outcome data published Oscar Health - Arizona
Oscar Health · AZ info appeals_not_reported no appeal outcome data published Oscar Health - Iowa
Oscar Health · IA info appeals_not_reported no appeal outcome data published Oscar Health - Kansas
Oscar Health · KS info appeals_not_reported no appeal outcome data published Oscar Health - Michigan
Oscar Health · MI info appeals_not_reported no appeal outcome data published Oscar Health - Missouri
Oscar Health · MO info appeals_not_reported no appeal outcome data published Oscar Health - Nebraska
Oscar Health · NE info appeals_not_reported no appeal outcome data published Oscar Health - North Carolina
Oscar Health · NC info appeals_not_reported no appeal outcome data published Oscar Health - Ohio (issuer 29341)
Oscar Health · OH info appeals_not_reported no appeal outcome data published Oscar Health - Ohio (issuer 45845)
Oscar Health · OH info appeals_not_reported no appeal outcome data published Oscar Health - Oklahoma
Oscar Health · OK info appeals_not_reported no appeal outcome data published Oscar Health - Tennessee
Oscar Health · TN info appeals_not_reported no appeal outcome data published Oscar Health - Texas
Oscar Health · TX info appeals_not_reported no appeal outcome data published Umpqua Health Alliance
Umpqua Health · OR info appeals_not_reported no appeal outcome data published VillageCareMAX Managed Long-Term Care
VillageCare · NY info appeals_not_reported no appeal outcome data published VillageCareMAX Medicare (all plans, aggregated)
VillageCare · NY info appeals_not_reported no appeal outcome data published VillageCareMAX Total Advantage (D-SNP) - Medicaid requests
VillageCare · NY info appeals_not_reported no appeal outcome data published