Every filing checked against itself

std_counts_reconcile error 19 approved + denied ≠ stated total see 19 → exp_counts_reconcile error 13 same, expedited see 13 → appeals_exceed_total error 1 more overturns than appeals filed see 1 → expedited_slower_than_standard warn 20 expedited turnaround exceeding standard see 20 → high_denial_rate warn 11 rates far outside the peer range see 11 → expedited_exceeds_standard_volume warn 10 transposed standard/expedited columns see 10 → zero_denial_rate warn 7 0% denial reported see 7 → std_headline_excludes_extended warn 1 extended-review cases outside the headline see 1 → appeals_not_reported info 139 no appeal outcome published see 139 → percentages_only info 119 no counts, so arithmetic cannot be checked see 119 →

Wisconsin Medicaid (ForwardHealth) -- specific program/agency not named in document
Wisconsin Department of Health Services · WI info appeals_not_reported no appeal outcome data published Molina Healthcare of Washington (Apple Health)
Molina Healthcare · WA info appeals_not_reported no appeal outcome data published Med-QUEST aggregate (QUEST Integration plans plus FFS)
Hawaii Med-QUEST · HI info appeals_not_reported no appeal outcome data published Meridian Michigan Medicaid
Centene · MI info appeals_not_reported no appeal outcome data published AmeriHealth Caritas Louisiana
AmeriHealth Caritas · LA info appeals_not_reported no appeal outcome data published Wellpoint Washington (Apple Health)
Elevance Health · WA info appeals_not_reported no appeal outcome data published Macomb County Community Mental Health
Macomb County Community Mental Health · MI info appeals_not_reported no appeal outcome data published UnitedHealthcare Medicare Advantage H0169
UnitedHealth Group info appeals_not_reported no appeal outcome data published NH Healthy Families
Centene · NH info appeals_not_reported no appeal outcome data published Wyoming Medicaid Home and Community Based Services
Wyoming Department of Health · WY info appeals_not_reported no appeal outcome data published Ohio Medicaid Fee-for-Service
Ohio Department of Medicaid · OH info appeals_not_reported no appeal outcome data published Utah Medicaid
Utah DHHS · UT info appeals_not_reported no appeal outcome data published Advanced Health
Advanced Health · OR info appeals_not_reported no appeal outcome data published Colorado Access
Colorado Access · CO info appeals_not_reported no appeal outcome data published Yamhill Community Care
Yamhill Community Care · OR info appeals_not_reported no appeal outcome data published Health Plan of San Mateo
Health Plan of San Mateo · CA info appeals_not_reported no appeal outcome data published AmeriHealth Caritas Delaware CHIP
AmeriHealth Caritas Family of Companies · DE info appeals_not_reported no appeal outcome data published Wyoming High Fidelity Wraparound CME
Magellan Healthcare · WY info appeals_not_reported no appeal outcome data published Peak Health
Peak Health · WV info appeals_not_reported no appeal outcome data published Highmark Medicare Advantage contract H7710
Highmark · DE info appeals_not_reported no appeal outcome data published Generations Advantage HMO - Behavioral Health
Martin's Point Health Care · ME info appeals_not_reported no appeal outcome data published Generations Advantage LPPO - Behavioral Health
Martin's Point Health Care · ME info appeals_not_reported no appeal outcome data published Blue Cross and Blue Shield of Minnesota (Blue Cross plans)
Blue Cross and Blue Shield of Minnesota · MN info appeals_not_reported no appeal outcome data published Blue Plus (Blue Cross and Blue Shield of Minnesota)
Blue Cross and Blue Shield of Minnesota · MN info appeals_not_reported no appeal outcome data published BCBSNE Medicare Advantage HMO
Blue Cross and Blue Shield of Nebraska · NE info appeals_not_reported no appeal outcome data published BCBSNE Medicare Advantage PPO
Blue Cross and Blue Shield of Nebraska · NE info appeals_not_reported no appeal outcome data published BCBSNE Qualified Health Plans
Blue Cross and Blue Shield of Nebraska · NE info appeals_not_reported no appeal outcome data published Blue Cross NC ACA (Marketplace) plans
Blue Cross and Blue Shield of North Carolina · NC info appeals_not_reported no appeal outcome data published Blue Medicare Advantage (PPO)
Blue Cross and Blue Shield of North Carolina · NC info appeals_not_reported no appeal outcome data published Experience Health Medicare Advantage (HMO)
Blue Cross and Blue Shield of North Carolina · NC info appeals_not_reported no appeal outcome data published Healthy Blue + Medicare (HMO-POS D-SNP)
Blue Cross and Blue Shield of North Carolina · NC info appeals_not_reported no appeal outcome data published CareSource Georgia (Georgia Families)
CareSource · GA info appeals_not_reported no appeal outcome data published Cascade Health Alliance
Cascade Health Alliance · OR info appeals_not_reported no appeal outcome data published Cigna Individual & Family Plans (FFE)
Cigna info appeals_not_reported no appeal outcome data published Calendar Year 2025 Prior Authorization Metrics (program not named in document)
Commonwealth of Massachusetts · MA info appeals_not_reported no appeal outcome data published Aetna Better Health Premier Plan (Medicare-Medicaid)
CVS Health / Aetna · IL info appeals_not_reported no appeal outcome data published Aetna Better Health Premier Plan Michigan
CVS Health / Aetna · MI info appeals_not_reported no appeal outcome data published Aetna Medicare Advantage - contract H0523
CVS Health / Aetna info appeals_not_reported no appeal outcome data published Aetna Medicare Advantage - contract H0562
CVS Health / Aetna info appeals_not_reported no appeal outcome data published Aetna Medicare Advantage - contract H0628
CVS Health / Aetna info appeals_not_reported no appeal outcome data published Aetna Medicare Advantage - contract H1109
CVS Health / Aetna info appeals_not_reported no appeal outcome data published Aetna Medicare Advantage - contract H1206
CVS Health / Aetna info appeals_not_reported no appeal outcome data published Aetna Medicare Advantage - contract H1608
CVS Health / Aetna info appeals_not_reported no appeal outcome data published Aetna Medicare Advantage - contract H1609
CVS Health / Aetna info appeals_not_reported no appeal outcome data published Aetna Medicare Advantage - contract H1692
CVS Health / Aetna info appeals_not_reported no appeal outcome data published Aetna Medicare Advantage - contract H2056
CVS Health / Aetna info appeals_not_reported no appeal outcome data published Aetna Medicare Advantage - contract H2293
CVS Health / Aetna info appeals_not_reported no appeal outcome data published Aetna Medicare Advantage - contract H2663
CVS Health / Aetna info appeals_not_reported no appeal outcome data published Aetna Medicare Advantage - contract H3146
CVS Health / Aetna info appeals_not_reported no appeal outcome data published Aetna Medicare Advantage - contract H3219
CVS Health / Aetna info appeals_not_reported no appeal outcome data published Aetna Medicare Advantage - contract H3239
CVS Health / Aetna info appeals_not_reported no appeal outcome data published Aetna Medicare Advantage - contract H3288
CVS Health / Aetna info appeals_not_reported no appeal outcome data published Aetna Medicare Advantage - contract H3312
CVS Health / Aetna info appeals_not_reported no appeal outcome data published Aetna Medicare Advantage - contract H3597
CVS Health / Aetna info appeals_not_reported no appeal outcome data published Aetna Medicare Advantage - contract H3748
CVS Health / Aetna info appeals_not_reported no appeal outcome data published Aetna Medicare Advantage - contract H3928
CVS Health / Aetna info appeals_not_reported no appeal outcome data published Aetna Medicare Advantage - contract H3931
CVS Health / Aetna info appeals_not_reported no appeal outcome data published Aetna Medicare Advantage - contract H3959
CVS Health / Aetna info appeals_not_reported no appeal outcome data published Aetna Medicare Advantage - contract H4523
CVS Health / Aetna info appeals_not_reported no appeal outcome data published Aetna Medicare Advantage - contract H4711
CVS Health / Aetna info appeals_not_reported no appeal outcome data published