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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

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

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

zero_denial_rate · 7 hits

0% denial reported Show all 340

Plan

Severity

Rule

Detail

Wyoming Medicaid Home and Community Based Services
Wyoming Department of Health · WY warn zero_denial_rate 0% denial rate reported Wyoming High Fidelity Wraparound CME
Magellan Healthcare · WY warn zero_denial_rate 0% denial rate reported Generations Advantage HMO - Behavioral Health
Martin's Point Health Care · ME warn zero_denial_rate 0% denial rate reported Generations Advantage LPPO - Behavioral Health
Martin's Point Health Care · ME warn zero_denial_rate 0% denial rate reported UnitedHealthcare Medicare Advantage - Contract H4032
UnitedHealth Group warn zero_denial_rate 0% denial rate reported Aetna Medicare Advantage - contract H0562
CVS Health / Aetna warn zero_denial_rate 0% denial rate reported Senior Whole Health of New York - FIDE
Molina Healthcare · NY warn zero_denial_rate 0% denial rate reported