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

high_denial_rate · 11 hits

rates far outside the peer range Show all 340
Plan
Severity
Rule
Detail
Prepaid Medical Assistance Program (PMAP)
UCare · MN warn high_denial_rate 47.8% standard denial rate is far above the peer range UCare Connect
UCare · MN warn high_denial_rate 45.18% standard denial rate is far above the peer range MinnesotaCare (MnCare)
UCare · MN warn high_denial_rate 45.14% standard denial rate is far above the peer range UCare Minnesota Senior Health Options (MSHO)
UCare · MN warn high_denial_rate 43.92% standard denial rate is far above the peer range UCare Connect + Medicare
UCare · MN warn high_denial_rate 46.57% standard denial rate is far above the peer range AmeriHealth Caritas Delaware CHIP
AmeriHealth Caritas Family of Companies · DE warn high_denial_rate 48.41% standard denial rate is far above the peer range Minnesota Senior Care Plus (MSC+)
UCare · MN warn high_denial_rate 41.87% standard denial rate is far above the peer range Texas MMP
UnitedHealth Group · TX warn high_denial_rate 40.42% standard denial rate is far above the peer range Hamaspik Choice (MLTC)
Hamaspik · NY warn high_denial_rate 49% standard denial rate is far above the peer range Hamaspik Medicare Choice (MAP - Medicaid side)
Hamaspik · NY warn high_denial_rate 52% standard denial rate is far above the peer range VillageCareMAX Managed Long-Term Care
VillageCare · NY warn high_denial_rate 62.3% standard denial rate is far above the peer range