03 · Validation
Every filing checked against itself
Rule
Severity
Hits
Catches
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
33 error findings
Show all 340Plan
Severity
Rule
Detail
Sentara Health · VA error appeals_exceed_total 134 overturned exceeds 127 appeals filed Geisinger Health Plan (all lines of business, aggregated)
Geisinger Health · PA error exp_counts_reconcile 2,830 approved + 168 denied = 2,998, but total is 3,039 (41 unaccounted, 1.3%) AmeriHealth Caritas Louisiana
AmeriHealth Caritas · LA error exp_counts_reconcile 1,697 approved + 114 denied = 1,811, but total is 1,821 (10 unaccounted, 0.5%) AmeriHealth Caritas North Carolina
AmeriHealth Caritas · NC error exp_counts_reconcile 1,192 approved + 174 denied = 1,366, but total is 1,410 (44 unaccounted, 3.1%) Contra Costa Health Plan (Medi-Cal)
Contra Costa Health · CA error exp_counts_reconcile 6,167 approved + 885 denied = 7,052, but total is 7,676 (624 unaccounted, 8.1%) Jackson Care Connect
CareOregon · OR error exp_counts_reconcile 3,623 approved + 157 denied = 3,780, but total is 3,749 (-31 unaccounted, 0.8%) Community First Texas Medicaid STAR
Community First Health Plans · TX error exp_counts_reconcile 7,178 approved + 276 denied = 7,454, but total is 8,994 (1,540 unaccounted, 17.1%) AmeriHealth Caritas New Hampshire
AmeriHealth Caritas Family of Companies · NH error exp_counts_reconcile 778 approved + 129 denied = 907, but total is 934 (27 unaccounted, 2.9%) Columbia Pacific CCO
CareOregon · OR error exp_counts_reconcile 2,582 approved + 148 denied = 2,730, but total is 2,712 (-18 unaccounted, 0.7%) Community First Texas Medicaid STAR+PLUS
Community First Health Plans · TX error exp_counts_reconcile 4,242 approved + 233 denied = 4,475, but total is 5,421 (946 unaccounted, 17.5%) AmeriHealth Caritas VIP Care (Michigan)
AmeriHealth Caritas Family of Companies · MI error exp_counts_reconcile 452 approved + 64 denied = 516, but total is 521 (5 unaccounted, 1.0%) University Community Care Plan (Marketplace)
Community First Health Plans · TX error exp_counts_reconcile 358 approved + 28 denied = 386, but total is 499 (113 unaccounted, 22.6%) Community First CHIP
Community First Health Plans · TX error exp_counts_reconcile 174 approved + 24 denied = 198, but total is 242 (44 unaccounted, 18.2%) Community First Medicare Advantage (Alamo & D-SNP)
Community First Health Plans · TX error exp_counts_reconcile 110 approved + 7 denied = 117, but total is 142 (25 unaccounted, 17.6%) Keystone First
AmeriHealth Caritas · PA error std_counts_reconcile 234,056 approved + 89,408 denied = 323,464, but total is 314,611 (-8,853 unaccounted, 2.8%) Wisconsin Medicaid (ForwardHealth) -- specific program/agency not named in document
Wisconsin Department of Health Services · WI error std_counts_reconcile 148,796 approved + 6,556 denied = 155,352, but total is 165,012 (9,660 unaccounted, 5.9%) AmeriHealth Caritas Louisiana
AmeriHealth Caritas · LA error std_counts_reconcile 76,939 approved + 9,398 denied = 86,337, but total is 87,451 (1,114 unaccounted, 1.3%) AmeriHealth Caritas North Carolina
AmeriHealth Caritas · NC error std_counts_reconcile 65,448 approved + 11,698 denied = 77,146, but total is 77,905 (759 unaccounted, 1.0%) First Choice by Select Health of South Carolina
AmeriHealth Caritas Family of Companies · SC error std_counts_reconcile 57,563 approved + 13,195 denied = 70,758, but total is 72,229 (1,471 unaccounted, 2.0%) Contra Costa Health Plan (Medi-Cal)
Contra Costa Health · CA error std_counts_reconcile 51,203 approved + 6,741 denied = 57,944, but total is 61,899 (3,955 unaccounted, 6.4%) Mississippi Medicaid Fee-for-Service
Mississippi Division of Medicaid · MS error std_counts_reconcile 52,480 approved + 6,119 denied = 58,599, but total is 60,252 (1,653 unaccounted, 2.7%) NH Healthy Families
Centene · NH error std_counts_reconcile 33,320 approved + 5,310 denied = 38,630, but total is 39,685 (1,055 unaccounted, 2.7%) Jackson Care Connect
CareOregon · OR error std_counts_reconcile 32,263 approved + 2,631 denied = 34,894, but total is 34,544 (-350 unaccounted, 1.0%) Community First Texas Medicaid STAR
Community First Health Plans · TX error std_counts_reconcile 18,828 approved + 955 denied = 19,783, but total is 20,481 (698 unaccounted, 3.4%) AmeriHealth Caritas New Hampshire
AmeriHealth Caritas Family of Companies · NH error std_counts_reconcile 13,815 approved + 3,265 denied = 17,080, but total is 17,385 (305 unaccounted, 1.8%) Columbia Pacific CCO
CareOregon · OR error std_counts_reconcile 14,569 approved + 1,230 denied = 15,799, but total is 15,531 (-268 unaccounted, 1.7%) Community First Texas Medicaid STAR Kids
Community First Health Plans · TX error std_counts_reconcile 10,773 approved + 638 denied = 11,411, but total is 12,378 (967 unaccounted, 7.8%) Wyoming Medicaid Utilization Management (FFS)
Wyoming Department of Health · WY error std_counts_reconcile 9,294 approved + 1,106 denied = 10,400, but total is 10,708 (308 unaccounted, 2.9%) Community First Texas Medicaid STAR+PLUS
Community First Health Plans · TX error std_counts_reconcile 7,715 approved + 646 denied = 8,361, but total is 8,980 (619 unaccounted, 6.9%) Michigan Medicaid Home and Community Based Services (Aging and Community Services Division, incl. Brain Injury Services and Community Transition Services) - Fee-for-Service
Michigan Department of Health and Human Services · MI error std_counts_reconcile 3,165 approved + 175 denied = 3,340, but total is 3,371 (31 unaccounted, 0.9%) University Community Care Plan (Marketplace)
Community First Health Plans · TX error std_counts_reconcile 2,631 approved + 76 denied = 2,707, but total is 2,726 (19 unaccounted, 0.7%) Community First Medicare Advantage (Alamo & D-SNP)
Community First Health Plans · TX error std_counts_reconcile 482 approved + 13 denied = 495, but total is 508 (13 unaccounted, 2.6%) Harvard Pilgrim Health Care – New Hampshire Exchange Local Choice
Point32Health · NH error std_counts_reconcile 150 approved + 29 denied = 179, but total is 182 (3 unaccounted, 1.6%)