Compcare Health Serv Ins Co(Anthem BCBS) (Wisconsin) in-network claim denial rate: 7.7%

In the CMS Transparency in Coverage file for plan year 2025, Compcare Health Serv Ins Co(Anthem BCBS) reported denying 81,887 of 1,063,009 in-network claims (7.7%) in Wisconsin, from 2023 claims. 41.8% of internal appeals were overturned (66 of 158). That is the 12th highest reported rate of 13 ranked issuers in Wisconsin; the state median is 10.3%.

Denial rate

7.7%

81,887 of 1,063,009 claims

Appeals overturned

41.8%

66 of 158 filed

External review overturned

0.0%

0 of 0 filed

Prior file (plan year 2024, 2022 claims): denial rate 26.9% (68,701 of 255,744); appeal overturn rate 55.0%.

Compared with Wisconsin and the national median

Measure	Compcare Health Serv Ins Co(Anthem BCBS)	Wisconsin median	National median
In-network denial rate	7.7%	10.3%	18.3%
In-network claims received	1,063,009	—	—
Internal appeals filed	158	—	—
Internal appeal overturn rate	41.8%	49.4%	41.7%
External reviews filed	0	—	—
External review overturn rate	0.0%	0.0%	0.0%
Out-of-network denial rate	61.8%	—	—

Medians are across issuers with at least 1,000 in-network claims received in the same file (Wisconsin: 13 issuers; national: 176 issuers in 32 states). Plan year 2025 file, 2023 claims.

Read these numbers carefully

Reporting lag: the CMS public-use file for a plan year reports claims from two plan years earlier (the PY2025 file carries 2023 claims). These are not this year's figures.
In-network only: the denial rate is in-network claims denied divided by in-network claims received. Out-of-network claims are shown separately where the issuer reported them.
"Denied" is broad: CMS counts every denial, including administrative denials, duplicate submissions, ineligibility, incorrect billing and partial denials, not only medical-necessity decisions.
Issuer level: CMS reports the counts once per issuer per state and repeats them on every plan row; plan-level counts, where present, list denials only, so no per-plan rate is computed.
Coverage: only issuers on the federally facilitated marketplace (HealthCare.gov states) report to this file. Employer plans, Medicare and Medicaid are not included.
No inference of intent: a higher rate can reflect the issuer's mix of claims, its billing rules or its membership as much as its coverage decisions. Compare with the state median and read the N.

Source: CMS Transparency in Coverage Public Use File (Health Insurance Exchange PUFs), plan year 2025; data dictionary. Issuer's own claims-payment policy page: https://www.anthem.com/ms/claims/home.html.

If Compcare Health Serv Ins Co(Anthem BCBS) denied your claim

A denial is a decision you can contest. Marketplace plans must give you at least 180 days to file an internal appeal and offer independent external review after it (45 CFR 147.136). The letter states your deadline.

Plans in this filing (72)

Where CMS lists plan-level denial counts they are shown; no plan-level rate is computed because the file does not give plan-level claims received.

Plan ID	Type	Metal	Plan-level denials (in-network)
79475WI0340102	HMO	Bronze	315
79475WI0340103	HMO	Bronze	443
79475WI0340106	HMO	Silver	550
79475WI0340109	HMO	Silver	4,958
79475WI0340110	HMO	Gold	1,033
79475WI0340111	HMO	Bronze	1,613
79475WI0340132	HMO	Bronze	204
79475WI0340133	HMO	Bronze	109
79475WI0340134	HMO	Bronze	766
79475WI0340141	HMO	Bronze	187
79475WI0340142	HMO	Bronze	40
79475WI0340143	HMO	Bronze	268
79475WI0340150	HMO	Silver	92
79475WI0340151	HMO	Silver	65
79475WI0340152	HMO	Silver	603
79475WI0340156	HMO	Silver	979
79475WI0340157	HMO	Silver	629
79475WI0340158	HMO	Silver	2,614
79475WI0340159	HMO	Gold	335
79475WI0340160	HMO	Gold	189
79475WI0340161	HMO	Gold	994
79475WI0340162	HMO	Bronze	751
79475WI0340163	HMO	Bronze	424
79475WI0340164	HMO	Bronze	719
79475WI0340169	HMO	Bronze	522
79475WI0340170	HMO	Silver	9,787
79475WI0340171	HMO	Gold	706
79475WI0340178	HMO	Bronze	483
79475WI0340179	HMO	Gold	259
79475WI0340180	HMO	Silver	631
79475WI0340181	HMO	Silver	409
79475WI0340183	HMO	Gold	490
79475WI0340184	HMO	Silver	2,500
79475WI0340186	HMO	Gold	98
79475WI0340187	HMO	Bronze	134
79475WI0340188	HMO	Bronze	131
79475WI0340212	HMO	Bronze	n/a
79475WI0340213	HMO	Bronze	n/a
79475WI0340214	HMO	Silver	n/a
79475WI0340215	HMO	Silver	n/a
79475WI0340218	HMO	Gold	n/a
79475WI0340219	HMO	Gold	n/a
79475WI0340220	HMO	Bronze	n/a
79475WI0340221	HMO	Bronze	n/a
79475WI0340222	HMO	Silver	n/a
79475WI0340223	HMO	Silver	n/a
79475WI0340224	HMO	Bronze	n/a
79475WI0340225	HMO	Bronze	n/a
79475WI0340226	HMO	Bronze	n/a
79475WI0340227	HMO	Bronze	n/a
79475WI0340230	HMO	Gold	n/a
79475WI0340231	HMO	Gold	n/a
79475WI0340232	HMO	Silver	n/a
79475WI0340233	HMO	Silver	n/a
79475WI0340251	HMO	Bronze	n/a
79475WI0340252	HMO	Silver	n/a
79475WI0340253	HMO	Gold	n/a
79475WI0340254	HMO	Bronze	n/a
79475WI0340255	HMO	Silver	n/a
79475WI0340256	HMO	Bronze	n/a

Showing 60 of 72 plans; all rows are in the CSV download.

Questions

What counts as a "denied" claim in Compcare Health Serv Ins Co(Anthem BCBS)'s 7.7% rate?

Every in-network claim the issuer reported as denied in the 2023 claims year, including administrative denials, duplicates, ineligibility, incorrect billing and partial denials, not only medical-necessity decisions. The figure is in-network claims denied divided by in-network claims received, exactly as reported to CMS.

Why is the data from 2023 when the file is for plan year 2025?

CMS's Transparency in Coverage public use file for a plan year reports claims data from two plan years earlier. This is the most recent issuer-level denial data CMS publishes for marketplace plans.

Does this predict whether my Compcare Health Serv Ins Co(Anthem BCBS) claim will be denied?

No. It is an aggregate across all of the issuer's marketplace plans in Wisconsin. Your own claim depends on your plan, the service and the documentation. Compare the rate with the Wisconsin median (10.3%) and read the N before drawing conclusions.

How do I appeal a Compcare Health Serv Ins Co(Anthem BCBS) denial?

Read the denial letter for the reason and the deadline, request the criteria and the claim file in writing, and file an internal appeal (at least 180 days on marketplace plans under 45 CFR 147.136). In the reporting year, 41.8% of internal appeals to this issuer were overturned (66 of 158). If the internal appeal fails, independent external review is available.

Ask an AI assistant about this page:ChatGPT Perplexity Google AI ClaudeOpens in a new tab with a question about this page. Nothing about you is sent.

Cite: Apellica Insurer Denial Report Cards, Compcare Health Serv Ins Co(Anthem BCBS) (Wisconsin), plan year 2025, from the CMS Transparency in Coverage PUF. CC BY 4.0. Download the full table as CSV or read the methodology. Corrections: editorial@apellica.com.