Project 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
28
of 658 filings publish numbers that do not reconcile against themselves
125
publish percentages with no counts at all
145
publish no appeal outcome
363
total findings across 658 filings
Rule
Severity
Hits
Catches
std_counts_reconcile error 22 approved + denied ≠ stated total exp_counts_reconcile error 14 same, expedited appeals_exceed_total error 3 more overturns than appeals filed expedited_slower_than_standard warn 23 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 8 0% denial reported std_headline_excludes_extended warn 2 extended-review cases outside the headline appeals_not_reported info 145 no appeal outcome published percentages_only info 125 no counts, so arithmetic cannot be checked

std_headline_excludes_extended · 2 hits

extended-review cases outside the headline Show all 363
Plan
Severity
Rule
Detail
Medi-Cal and CHIP (fee-for-service)
California Department of Health Care Services · CA warn std_headline_excludes_extended headline approved/denied cover 78,145 of 78,987; the 842 balance is reported separately as extended review, so the published percentages understate the full population Medi-Cal Fee-for-Service (medical and behavioral health)
California DHCS · CA warn std_headline_excludes_extended headline approved/denied cover 78,145 of 78,987; the 842 balance is reported separately as extended review, so the published percentages understate the full population