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

expedited_exceeds_standard_volume · 10 hits

transposed standard/expedited columns Show all 340
Plan
Severity
Rule
Detail
Colorado Access
Colorado Access · CO warn expedited_exceeds_standard_volume expedited volume 17,006 exceeds standard 16,654 (1.0x) - columns may be transposed Rocky Mountain Health Plans RAE (Medicaid Regional Accountable Entity)
Rocky Mountain Health Plans · CO warn expedited_exceeds_standard_volume expedited volume 8,660 exceeds standard 8,244 (1.1x) - columns may be transposed Highmark Medicare Advantage contract H5932
Highmark · PA warn expedited_exceeds_standard_volume expedited volume 11,889 exceeds standard 7,010 (1.7x) - columns may be transposed Northeast Health Partners (Regional Accountable Entity)
Northeast Health Partners · CO warn expedited_exceeds_standard_volume expedited volume 6,572 exceeds standard 4,203 (1.6x) - columns may be transposed Aetna Better Health Kids (Pennsylvania CHIP)
CVS Health / Aetna · PA warn expedited_exceeds_standard_volume expedited volume 2,990 exceeds standard 2,066 (1.4x) - columns may be transposed Rocky Mountain Health Plans - QHP On-Exchange
Rocky Mountain Health Plans · CO warn expedited_exceeds_standard_volume expedited volume 4,534 exceeds standard 1,418 (3.2x) - columns may be transposed Rocky Mountain Health Plans PRIME (Medicaid)
Rocky Mountain Health Plans · CO warn expedited_exceeds_standard_volume expedited volume 8,068 exceeds standard 1,336 (6.0x) - columns may be transposed Peak Health
Peak Health · WV warn expedited_exceeds_standard_volume expedited volume 4,664 exceeds standard 937 (5.0x) - columns may be transposed Rocky Mountain Health Plans Medicare Advantage
Rocky Mountain Health Plans · CO warn expedited_exceeds_standard_volume expedited volume 465 exceeds standard 294 (1.6x) - columns may be transposed Generations Advantage HMO - Behavioral Health
Martin's Point Health Care · ME warn expedited_exceeds_standard_volume expedited volume 166 exceeds standard 131 (1.3x) - columns may be transposed