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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

appeals_not_reported info 139 no appeal outcome published percentages_only info 119 no counts, so arithmetic cannot be checked

of 536 filings publish numbers that do not reconcile against themselves

publish percentages with no counts at all

publish no appeal outcome

total findings across 536 filings

percentages_only · 119 hits

no counts, so arithmetic cannot be checked Show all 340

Plan

Severity

Rule

Detail

Med-QUEST aggregate (QUEST Integration plans plus FFS)
Hawaii Med-QUEST · HI info percentages_only filing publishes percentages without underlying counts; arithmetic cannot be verified Meridian Michigan Medicaid
Centene · MI info percentages_only filing publishes percentages without underlying counts; arithmetic cannot be verified Wyoming High Fidelity Wraparound CME
Magellan Healthcare · WY info percentages_only filing publishes percentages without underlying counts; arithmetic cannot be verified BCBSNE Medicare Advantage HMO
Blue Cross and Blue Shield of Nebraska · NE info percentages_only filing publishes percentages without underlying counts; arithmetic cannot be verified BCBSNE Medicare Advantage PPO
Blue Cross and Blue Shield of Nebraska · NE info percentages_only filing publishes percentages without underlying counts; arithmetic cannot be verified BCBSNE Qualified Health Plans
Blue Cross and Blue Shield of Nebraska · NE info percentages_only filing publishes percentages without underlying counts; arithmetic cannot be verified Blue Cross NC ACA (Marketplace) plans
Blue Cross and Blue Shield of North Carolina · NC info percentages_only filing publishes percentages without underlying counts; arithmetic cannot be verified Blue Medicare Advantage (PPO)
Blue Cross and Blue Shield of North Carolina · NC info percentages_only filing publishes percentages without underlying counts; arithmetic cannot be verified Experience Health Medicare Advantage (HMO)
Blue Cross and Blue Shield of North Carolina · NC info percentages_only filing publishes percentages without underlying counts; arithmetic cannot be verified Healthy Blue + Medicare (HMO-POS D-SNP)
Blue Cross and Blue Shield of North Carolina · NC info percentages_only filing publishes percentages without underlying counts; arithmetic cannot be verified CareSource Georgia (Georgia Families)
CareSource · GA info percentages_only filing publishes percentages without underlying counts; arithmetic cannot be verified Cascade Health Alliance
Cascade Health Alliance · OR info percentages_only filing publishes percentages without underlying counts; arithmetic cannot be verified Cigna Individual & Family Plans (FFE)
Cigna info percentages_only filing publishes percentages without underlying counts; arithmetic cannot be verified Calendar Year 2025 Prior Authorization Metrics (program not named in document)
Commonwealth of Massachusetts · MA info percentages_only filing publishes percentages without underlying counts; arithmetic cannot be verified Aetna Better Health Premier Plan (Medicare-Medicaid)
CVS Health / Aetna · IL info percentages_only filing publishes percentages without underlying counts; arithmetic cannot be verified Aetna Better Health Premier Plan Michigan
CVS Health / Aetna · MI info percentages_only filing publishes percentages without underlying counts; arithmetic cannot be verified Aetna Medicare Advantage - contract H0523
CVS Health / Aetna info percentages_only filing publishes percentages without underlying counts; arithmetic cannot be verified Aetna Medicare Advantage - contract H0562
CVS Health / Aetna info percentages_only filing publishes percentages without underlying counts; arithmetic cannot be verified Aetna Medicare Advantage - contract H0628
CVS Health / Aetna info percentages_only filing publishes percentages without underlying counts; arithmetic cannot be verified Aetna Medicare Advantage - contract H1109
CVS Health / Aetna info percentages_only filing publishes percentages without underlying counts; arithmetic cannot be verified Aetna Medicare Advantage - contract H1206
CVS Health / Aetna info percentages_only filing publishes percentages without underlying counts; arithmetic cannot be verified Aetna Medicare Advantage - contract H1608
CVS Health / Aetna info percentages_only filing publishes percentages without underlying counts; arithmetic cannot be verified Aetna Medicare Advantage - contract H1609
CVS Health / Aetna info percentages_only filing publishes percentages without underlying counts; arithmetic cannot be verified Aetna Medicare Advantage - contract H1692
CVS Health / Aetna info percentages_only filing publishes percentages without underlying counts; arithmetic cannot be verified Aetna Medicare Advantage - contract H2056
CVS Health / Aetna info percentages_only filing publishes percentages without underlying counts; arithmetic cannot be verified Aetna Medicare Advantage - contract H2293
CVS Health / Aetna info percentages_only filing publishes percentages without underlying counts; arithmetic cannot be verified Aetna Medicare Advantage - contract H2663
CVS Health / Aetna info percentages_only filing publishes percentages without underlying counts; arithmetic cannot be verified Aetna Medicare Advantage - contract H3146
CVS Health / Aetna info percentages_only filing publishes percentages without underlying counts; arithmetic cannot be verified Aetna Medicare Advantage - contract H3219
CVS Health / Aetna info percentages_only filing publishes percentages without underlying counts; arithmetic cannot be verified Aetna Medicare Advantage - contract H3239
CVS Health / Aetna info percentages_only filing publishes percentages without underlying counts; arithmetic cannot be verified Aetna Medicare Advantage - contract H3288
CVS Health / Aetna info percentages_only filing publishes percentages without underlying counts; arithmetic cannot be verified Aetna Medicare Advantage - contract H3312
CVS Health / Aetna info percentages_only filing publishes percentages without underlying counts; arithmetic cannot be verified Aetna Medicare Advantage - contract H3597
CVS Health / Aetna info percentages_only filing publishes percentages without underlying counts; arithmetic cannot be verified Aetna Medicare Advantage - contract H3748
CVS Health / Aetna info percentages_only filing publishes percentages without underlying counts; arithmetic cannot be verified Aetna Medicare Advantage - contract H3928
CVS Health / Aetna info percentages_only filing publishes percentages without underlying counts; arithmetic cannot be verified Aetna Medicare Advantage - contract H3931
CVS Health / Aetna info percentages_only filing publishes percentages without underlying counts; arithmetic cannot be verified Aetna Medicare Advantage - contract H3959
CVS Health / Aetna info percentages_only filing publishes percentages without underlying counts; arithmetic cannot be verified Aetna Medicare Advantage - contract H4523
CVS Health / Aetna info percentages_only filing publishes percentages without underlying counts; arithmetic cannot be verified Aetna Medicare Advantage - contract H4711
CVS Health / Aetna info percentages_only filing publishes percentages without underlying counts; arithmetic cannot be verified Aetna Medicare Advantage - contract H4835
CVS Health / Aetna info percentages_only filing publishes percentages without underlying counts; arithmetic cannot be verified Aetna Medicare Advantage - contract H4982
CVS Health / Aetna info percentages_only filing publishes percentages without underlying counts; arithmetic cannot be verified Aetna Medicare Advantage - contract H5302
CVS Health / Aetna info percentages_only filing publishes percentages without underlying counts; arithmetic cannot be verified Aetna Medicare Advantage - contract H5309
CVS Health / Aetna info percentages_only filing publishes percentages without underlying counts; arithmetic cannot be verified Aetna Medicare Advantage - contract H5325
CVS Health / Aetna info percentages_only filing publishes percentages without underlying counts; arithmetic cannot be verified Aetna Medicare Advantage - contract H5337
CVS Health / Aetna info percentages_only filing publishes percentages without underlying counts; arithmetic cannot be verified Aetna Medicare Advantage - contract H5521
CVS Health / Aetna info percentages_only filing publishes percentages without underlying counts; arithmetic cannot be verified Aetna Medicare Advantage - contract H5522
CVS Health / Aetna info percentages_only filing publishes percentages without underlying counts; arithmetic cannot be verified Aetna Medicare Advantage - contract H5593
CVS Health / Aetna info percentages_only filing publishes percentages without underlying counts; arithmetic cannot be verified Aetna Medicare Advantage - contract H5793
CVS Health / Aetna info percentages_only filing publishes percentages without underlying counts; arithmetic cannot be verified Aetna Medicare Advantage - contract H7149
CVS Health / Aetna info percentages_only filing publishes percentages without underlying counts; arithmetic cannot be verified Aetna Medicare Advantage - contract H7301
CVS Health / Aetna info percentages_only filing publishes percentages without underlying counts; arithmetic cannot be verified Aetna Medicare Advantage - contract H8332
CVS Health / Aetna info percentages_only filing publishes percentages without underlying counts; arithmetic cannot be verified Aetna Medicare Advantage - contract H8597
CVS Health / Aetna info percentages_only filing publishes percentages without underlying counts; arithmetic cannot be verified Devoted Health (all MA plans, aggregated)
Devoted Health info percentages_only filing publishes percentages without underlying counts; arithmetic cannot be verified Driscoll Health Plan CHIP
Driscoll Health Plan · TX info percentages_only filing publishes percentages without underlying counts; arithmetic cannot be verified Driscoll Health Plan STAR
Driscoll Health Plan · TX info percentages_only filing publishes percentages without underlying counts; arithmetic cannot be verified Driscoll Health Plan STAR Kids
Driscoll Health Plan · TX info percentages_only filing publishes percentages without underlying counts; arithmetic cannot be verified Anthem HealthPlus New York Child Health Plus
Elevance Health · NY info percentages_only filing publishes percentages without underlying counts; arithmetic cannot be verified Anthem HealthPlus New York Medicaid
Elevance Health · NY info percentages_only filing publishes percentages without underlying counts; arithmetic cannot be verified Wellpoint District of Columbia
Elevance Health · DC info percentages_only filing publishes percentages without underlying counts; arithmetic cannot be verified