{ "meta": { "total": 20, "page": 1, "per_page": 50, "pages": 1, "sort": "rate", "direction": "desc", "reporting_year": "CY2025", "rule": "CMS-0057-F", "note": "Rates are computed from published counts. null means the payer published no value; it never means zero." }, "filings": [ { "filing_id": "f0140", "parent_org": "Centene", "plan_name": "Ambetter from Superior HealthPlan (29418)", "contract_id": "29418", "coverage_type": "Marketplace QHP", "state": "TX", "reporting_period": "CY2025", "std_total": 218062, "std_approved": 146238, "std_denied": 71824, "std_denial_rate": 32.94, "std_denial_rate_printed": null, "std_appeals_total": 3439, "std_appeals_overturned": 2129, "std_appeal_overturn_rate": 61.91, "exp_total": 6747, "exp_approved": 5145, "exp_denied": 1602, "exp_denial_rate": 23.74, "ext_review_approved": 29074, "std_tat_mean_days": 2, "std_tat_median_days": 1, "exp_tat_mean_hours": 72, "exp_tat_median_hours": 24, "reports_counts": true, "quality_flags": "warn:expedited_slower_than_standard", "error_count": 0, "warn_count": 1, "source_url": "https://www.ambetterhealth.com/content/dam/centene/Superior/Ambetter/PDFs/TX_MKT_ABSuperiorHealthPlan_29418_MetricsSummary_R.pdf", "source_segment": "wave2", "extraction_note": "contract_id is the HIOS issuer ID. 32.9% standard denial rate on 218,062 requests - the highest-volume high-denial filing in the dataset.", "source_sha256": null, "service_list_url": null, "service_list_items": null, "entity_id": "qhp:TX:29418", "filing_unit": "qhp_issuer" }, { "filing_id": "f0141", "parent_org": "Centene", "plan_name": "Ambetter from Superior HealthPlan (87226)", "contract_id": "87226", "coverage_type": "Marketplace QHP", "state": "TX", "reporting_period": "CY2025", "std_total": 89666, "std_approved": 60540, "std_denied": 29126, "std_denial_rate": 32.48, "std_denial_rate_printed": null, "std_appeals_total": 1297, "std_appeals_overturned": 779, "std_appeal_overturn_rate": 60.06, "exp_total": 4992, "exp_approved": 3453, "exp_denied": 1539, "exp_denial_rate": 30.83, "ext_review_approved": 13243, "std_tat_mean_days": 2, "std_tat_median_days": 1, "exp_tat_mean_hours": 72, "exp_tat_median_hours": 24, "reports_counts": true, "quality_flags": "warn:expedited_slower_than_standard", "error_count": 0, "warn_count": 1, "source_url": "https://www.ambetterhealth.com/content/dam/centene/Superior/Ambetter/PDFs/TX_MKT_ABSuperiorHealthPlan_87226_MetricsSummary_R.pdf", "source_segment": "wave2", "extraction_note": "contract_id is the HIOS issuer ID. 32.5% standard denial rate.", "source_sha256": null, "service_list_url": null, "service_list_items": null, "entity_id": "qhp:TX:87226", "filing_unit": "qhp_issuer" }, { "filing_id": "f0144", "parent_org": "Centene", "plan_name": "Ambetter of Oklahoma", "contract_id": null, "coverage_type": "Marketplace QHP", "state": "OK", "reporting_period": "CY2025", "std_total": 38282, "std_approved": 26755, "std_denied": 11527, "std_denial_rate": 30.11, "std_denial_rate_printed": 30.11, "std_appeals_total": 777, "std_appeals_overturned": 232, "std_appeal_overturn_rate": 29.86, "exp_total": 733, "exp_approved": 570, "exp_denied": 163, "exp_denial_rate": 22.24, "ext_review_approved": null, "std_tat_mean_days": 3, "std_tat_median_days": 1, "exp_tat_mean_hours": 48, "exp_tat_median_hours": 24, "reports_counts": true, "quality_flags": "clean", "error_count": 0, "warn_count": 0, "source_url": "https://www.ambetterhealth.com/content/dam/centene/ambetter-of-oklahoma/pdf/OK_MKT_ABofOK_62505_MetricsSummary_R.pdf", "source_segment": "w3_qhp", "extraction_note": "Issuer ID 62505. Expedited appeals: 52 total, 25 overturned (48.08%). Expedited TAT printed in days (mean 2, median 1); converted to hours (48h/24h) - native unit was days.", "source_sha256": null, "service_list_url": null, "service_list_items": null, "entity_id": "qhp:OK:62505", "filing_unit": "qhp_issuer" }, { "filing_id": "f0142", "parent_org": "Centene", "plan_name": "Ambetter of Alabama", "contract_id": null, "coverage_type": "Marketplace QHP", "state": "AL", "reporting_period": "CY2025", "std_total": 38711, "std_approved": 27669, "std_denied": 11042, "std_denial_rate": 28.52, "std_denial_rate_printed": 28.52, "std_appeals_total": 903, "std_appeals_overturned": 264, "std_appeal_overturn_rate": 29.24, "exp_total": 1252, "exp_approved": 964, "exp_denied": 288, "exp_denial_rate": 23, "ext_review_approved": null, "std_tat_mean_days": 2, "std_tat_median_days": 1, "exp_tat_mean_hours": 24, "exp_tat_median_hours": 24, "reports_counts": true, "quality_flags": "clean", "error_count": 0, "warn_count": 0, "source_url": "https://www.ambetterhealth.com/content/dam/centene/ambetterofalabama/pdfs/AL_MKT_ABofAL_53932_MetricsSummary_R.pdf", "source_segment": "w3_qhp", "extraction_note": "Issuer ID 53932. Expedited appeals: 60 total, 29 overturned (48.33%). Expedited TAT printed in days (mean 1, median 1); converted to hours (24h/24h) - native unit was days.", "source_sha256": null, "service_list_url": null, "service_list_items": null, "entity_id": "qhp:AL:53932", "filing_unit": "qhp_issuer" }, { "filing_id": "f0133", "parent_org": "Centene", "plan_name": "Ambetter from Buckeye Health Plan", "contract_id": null, "coverage_type": "Marketplace QHP", "state": "OH", "reporting_period": "CY2025", "std_total": 52991, "std_approved": 37954, "std_denied": 15037, "std_denial_rate": 28.38, "std_denial_rate_printed": 28.38, "std_appeals_total": 441, "std_appeals_overturned": 251, "std_appeal_overturn_rate": 56.92, "exp_total": 3499, "exp_approved": 2657, "exp_denied": 842, "exp_denial_rate": 24.06, "ext_review_approved": null, "std_tat_mean_days": 4, "std_tat_median_days": 2, "exp_tat_mean_hours": 24, "exp_tat_median_hours": 0, "reports_counts": true, "quality_flags": "clean", "error_count": 0, "warn_count": 0, "source_url": "https://www.ambetterhealth.com/content/dam/centene/Buckeye/Ambetter/PDFs/OH_MKT_ABBuckeyeHealthPlan_41047_MetricsSummary_R.pdf", "source_segment": "w3_qhp", "extraction_note": "Issuer ID 41047. Document also includes an expedited appeals line (61 total, 30 overturned, 49.18%) not captured in fixed fields; std/exp appeals overturned pct printed as 56.92%/49.18% respectively. Expedited TAT printed in days (mean 1 day, median 0 days); converted to hours per schema (24h mean, 0h median) - document's native unit is days, not hours, so treat with care.", "source_sha256": null, "service_list_url": null, "service_list_items": null, "entity_id": "qhp:OH:41047", "filing_unit": "qhp_issuer" }, { "filing_id": "f0130", "parent_org": "Centene", "plan_name": "Ambetter Health of Delaware", "contract_id": null, "coverage_type": "Marketplace QHP", "state": "DE", "reporting_period": "CY2025", "std_total": 2946, "std_approved": 2131, "std_denied": 815, "std_denial_rate": 27.66, "std_denial_rate_printed": 27.66, "std_appeals_total": 35, "std_appeals_overturned": 11, "std_appeal_overturn_rate": 31.43, "exp_total": 168, "exp_approved": 132, "exp_denied": 36, "exp_denial_rate": 21.43, "ext_review_approved": null, "std_tat_mean_days": 5, "std_tat_median_days": 4, "exp_tat_mean_hours": 24, "exp_tat_median_hours": 24, "reports_counts": true, "quality_flags": "clean", "error_count": 0, "warn_count": 0, "source_url": "https://www.ambetterhealth.com/content/dam/centene/ambetter-delaware/pdf/DE_MKT_AHofDE_64004_MetricsSummary_R.pdf", "source_segment": "w3_qhp", "extraction_note": "Issuer ID 64004. Expedited appeals: 6 total, 2 overturned (33.33%). Expedited TAT printed in days (mean 1, median 1); converted to hours (24h/24h) - native unit was days.", "source_sha256": null, "service_list_url": null, "service_list_items": null, "entity_id": "qhp:DE:64004", "filing_unit": "qhp_issuer" }, { "filing_id": "f0132", "parent_org": "Centene", "plan_name": "Ambetter from Arizona Complete Health (91450)", "contract_id": "91450", "coverage_type": "Marketplace QHP", "state": "AZ", "reporting_period": "CY2025", "std_total": 54027, "std_approved": 39983, "std_denied": 14044, "std_denial_rate": 25.99, "std_denial_rate_printed": null, "std_appeals_total": 378, "std_appeals_overturned": 141, "std_appeal_overturn_rate": 37.3, "exp_total": 3730, "exp_approved": 2834, "exp_denied": 896, "exp_denial_rate": 24.02, "ext_review_approved": 1039, "std_tat_mean_days": 4, "std_tat_median_days": 1, "exp_tat_mean_hours": 48, "exp_tat_median_hours": 24, "reports_counts": true, "quality_flags": "clean", "error_count": 0, "warn_count": 0, "source_url": "https://www.ambetterhealth.com/content/dam/centene/ambetteraz/pdfs/AZ_MKT_AZCompleteHealth_91450_MetricsSummary_R.pdf", "source_segment": "wave2", "extraction_note": "contract_id is the HIOS issuer ID.", "source_sha256": null, "service_list_url": null, "service_list_items": null, "entity_id": "qhp:AZ:91450", "filing_unit": "qhp_issuer" }, { "filing_id": "f0139", "parent_org": "Centene", "plan_name": "Ambetter from Sunflower Health Plan (34368)", "contract_id": "34368", "coverage_type": "Marketplace QHP", "state": "KS", "reporting_period": "CY2025", "std_total": 64114, "std_approved": 47752, "std_denied": 16362, "std_denial_rate": 25.52, "std_denial_rate_printed": null, "std_appeals_total": 1702, "std_appeals_overturned": 891, "std_appeal_overturn_rate": 52.35, "exp_total": 1628, "exp_approved": 1344, "exp_denied": 284, "exp_denial_rate": 17.44, "ext_review_approved": 56, "std_tat_mean_days": 5, "std_tat_median_days": 2, "exp_tat_mean_hours": 24, "exp_tat_median_hours": 0, "reports_counts": true, "quality_flags": "clean", "error_count": 0, "warn_count": 0, "source_url": "https://www.ambetterhealth.com/content/dam/centene/sunflower/ambetter/pdfs/KS_MKT_ABSunflowerHealth_34368_MetricsSummary_R.pdf", "source_segment": "wave2", "extraction_note": "contract_id is the HIOS issuer ID.", "source_sha256": null, "service_list_url": null, "service_list_items": null, "entity_id": "qhp:KS:34368", "filing_unit": "qhp_issuer" }, { "filing_id": "f0126", "parent_org": "Centene", "plan_name": "Ambetter Health (Indiana / MHS Indiana marketplace)", "contract_id": null, "coverage_type": "Marketplace QHP", "state": "IN", "reporting_period": "CY2025", "std_total": 56928, "std_approved": 42933, "std_denied": 13995, "std_denial_rate": 24.58, "std_denial_rate_printed": 24.58, "std_appeals_total": 1884, "std_appeals_overturned": 684, "std_appeal_overturn_rate": 36.31, "exp_total": 2976, "exp_approved": 2224, "exp_denied": 752, "exp_denial_rate": 25.27, "ext_review_approved": null, "std_tat_mean_days": 2, "std_tat_median_days": 1, "exp_tat_mean_hours": 24, "exp_tat_median_hours": 0, "reports_counts": true, "quality_flags": "clean", "error_count": 0, "warn_count": 0, "source_url": "https://www.ambetterhealth.com/content/dam/centene/mhsindiana/Ambetter/PDFs/IN_MKT_AH_35065_MetricsSummary_R.pdf", "source_segment": "w3_qhp", "extraction_note": "Issuer ID 35065; document prints plan name as 'Ambetter Health' with no explicit state label, but URL/site path confirms Indiana (MHS Indiana). Expedited appeals: 148 total, 86 overturned (58.11%). Expedited TAT printed in days (mean 1, median 0); converted to hours (24h/0h) - native unit was days.", "source_sha256": null, "service_list_url": null, "service_list_items": null, "entity_id": "qhp:IN:35065", "filing_unit": "qhp_issuer" }, { "filing_id": "f0135", "parent_org": "Centene", "plan_name": "Ambetter from Louisiana Healthcare Connections", "contract_id": null, "coverage_type": "Marketplace QHP", "state": "LA", "reporting_period": "CY2025", "std_total": 22862, "std_approved": 17318, "std_denied": 5544, "std_denial_rate": 24.25, "std_denial_rate_printed": 24.25, "std_appeals_total": 523, "std_appeals_overturned": 160, "std_appeal_overturn_rate": 30.59, "exp_total": 1230, "exp_approved": 919, "exp_denied": 311, "exp_denial_rate": 25.28, "ext_review_approved": null, "std_tat_mean_days": 3, "std_tat_median_days": 2, "exp_tat_mean_hours": 24, "exp_tat_median_hours": 0, "reports_counts": true, "quality_flags": "clean", "error_count": 0, "warn_count": 0, "source_url": "https://www.ambetterhealth.com/content/dam/centene/louisiana-health-connect/ambetter/pdf/LA_MKT_ABLAHealthcareConnect_90787_MetricsSummary_R.pdf", "source_segment": "w3_qhp", "extraction_note": "Issuer ID 90787. Expedited appeals: 33 total, 17 overturned (51.52%) - not in fixed fields. Expedited TAT printed in days (mean 1, median 0); converted to hours (24h/0h) per schema - native unit was days.", "source_sha256": null, "service_list_url": null, "service_list_items": null, "entity_id": "qhp:LA:90787", "filing_unit": "qhp_issuer" }, { "filing_id": "f0138", "parent_org": "Centene", "plan_name": "Ambetter from NH Healthy Families", "contract_id": null, "coverage_type": "Marketplace QHP", "state": "NH", "reporting_period": "CY2025", "std_total": 15855, "std_approved": 12191, "std_denied": 3664, "std_denial_rate": 23.11, "std_denial_rate_printed": 23.11, "std_appeals_total": 604, "std_appeals_overturned": 491, "std_appeal_overturn_rate": 81.29, "exp_total": 612, "exp_approved": 423, "exp_denied": 189, "exp_denial_rate": 30.88, "ext_review_approved": null, "std_tat_mean_days": 2, "std_tat_median_days": 0, "exp_tat_mean_hours": 24, "exp_tat_median_hours": 0, "reports_counts": true, "quality_flags": "clean", "error_count": 0, "warn_count": 0, "source_url": "https://www.ambetterhealth.com/content/dam/centene/NH%20Healthy%20Families/ambetter/PDFs/NH_MKT_NHHealthyFamilies_75841_MetricsSummary_R.pdf", "source_segment": "w3_qhp", "extraction_note": "Issuer ID 75841. Expedited appeals: 28 total, 23 overturned (82.14%). Expedited TAT printed in days (mean 1, median 0); converted to hours (24h/0h) - native unit was days.", "source_sha256": null, "service_list_url": null, "service_list_items": null, "entity_id": "qhp:NH:75841", "filing_unit": "qhp_issuer" }, { "filing_id": "f0134", "parent_org": "Centene", "plan_name": "Ambetter from Home State Health (99723)", "contract_id": "99723", "coverage_type": "Marketplace QHP", "state": "MO", "reporting_period": "CY2025", "std_total": 89747, "std_approved": 69279, "std_denied": 20468, "std_denial_rate": 22.81, "std_denial_rate_printed": null, "std_appeals_total": 2503, "std_appeals_overturned": 1441, "std_appeal_overturn_rate": 57.57, "exp_total": 2491, "exp_approved": 1923, "exp_denied": 568, "exp_denial_rate": 22.8, "ext_review_approved": 1430, "std_tat_mean_days": 2, "std_tat_median_days": 0, "exp_tat_mean_hours": 24, "exp_tat_median_hours": 0, "reports_counts": true, "quality_flags": "clean", "error_count": 0, "warn_count": 0, "source_url": "https://www.ambetterhealth.com/content/dam/centene/home-state-health/ambetter/pdfs/MO_MKT_ABHomeStateHealth_99723_MetricsSummary_R-1.pdf", "source_segment": "wave2", "extraction_note": "contract_id is the HIOS issuer ID.", "source_sha256": null, "service_list_url": null, "service_list_items": null, "entity_id": "qhp:MO:99723", "filing_unit": "qhp_issuer" }, { "filing_id": "f0145", "parent_org": "Centene", "plan_name": "Ambetter of Tennessee", "contract_id": null, "coverage_type": "Marketplace QHP", "state": "TN", "reporting_period": "CY2025", "std_total": 104566, "std_approved": 80766, "std_denied": 23800, "std_denial_rate": 22.76, "std_denial_rate_printed": 22.76, "std_appeals_total": 3238, "std_appeals_overturned": 2218, "std_appeal_overturn_rate": 68.5, "exp_total": 2475, "exp_approved": 2063, "exp_denied": 412, "exp_denial_rate": 16.65, "ext_review_approved": null, "std_tat_mean_days": 2, "std_tat_median_days": 1, "exp_tat_mean_hours": 24, "exp_tat_median_hours": 0, "reports_counts": true, "quality_flags": "clean", "error_count": 0, "warn_count": 0, "source_url": "https://www.ambetterhealth.com/content/dam/centene/ambettertn/pdfs/TN_MKT_ABofTN_70111_MetricsSummary_R.pdf", "source_segment": "w3_qhp", "extraction_note": "Issuer ID 70111. Expedited appeals: 148 total, 93 overturned (62.84%). Expedited TAT printed in days (mean 1, median 0); converted to hours (24h/0h) - native unit was days.", "source_sha256": null, "service_list_url": null, "service_list_items": null, "entity_id": "qhp:TN:70111", "filing_unit": "qhp_issuer" }, { "filing_id": "f0137", "parent_org": "Centene", "plan_name": "Ambetter from Meridian", "contract_id": null, "coverage_type": "Marketplace QHP", "state": "MI", "reporting_period": "CY2025", "std_total": 41967, "std_approved": 32463, "std_denied": 9504, "std_denial_rate": 22.65, "std_denial_rate_printed": 22.65, "std_appeals_total": 1518, "std_appeals_overturned": 771, "std_appeal_overturn_rate": 50.79, "exp_total": 2453, "exp_approved": 2008, "exp_denied": 445, "exp_denial_rate": 18.14, "ext_review_approved": null, "std_tat_mean_days": 3, "std_tat_median_days": 1, "exp_tat_mean_hours": 24, "exp_tat_median_hours": 0, "reports_counts": true, "quality_flags": "clean", "error_count": 0, "warn_count": 0, "source_url": "https://www.ambetterhealth.com/content/dam/centene/ambetter-from-meridian/PDFs/MI_MKT_ABMeridian_58594_MetricsSummary_R.pdf", "source_segment": "w3_qhp", "extraction_note": "Issuer ID 58594. Expedited appeals: 106 total, 63 overturned (59.43%). Expedited TAT printed in days (mean 1, median 0); converted to hours (24h/0h) - native unit was days. Document includes a disclaimer that posted data may differ from data submitted to state/federal regulators due to differing methodologies.", "source_sha256": null, "service_list_url": null, "service_list_items": null, "entity_id": "qhp:MI:58594", "filing_unit": "qhp_issuer" }, { "filing_id": "f0127", "parent_org": "Centene", "plan_name": "Ambetter Health (Nebraska Total Care marketplace)", "contract_id": null, "coverage_type": "Marketplace QHP", "state": "NE", "reporting_period": "CY2025", "std_total": 36793, "std_approved": 28533, "std_denied": 8260, "std_denial_rate": 22.45, "std_denial_rate_printed": 22.45, "std_appeals_total": 996, "std_appeals_overturned": 359, "std_appeal_overturn_rate": 36.04, "exp_total": 1605, "exp_approved": 1365, "exp_denied": 240, "exp_denial_rate": 14.95, "ext_review_approved": null, "std_tat_mean_days": 4, "std_tat_median_days": 2, "exp_tat_mean_hours": 24, "exp_tat_median_hours": 24, "reports_counts": true, "quality_flags": "clean", "error_count": 0, "warn_count": 0, "source_url": "https://www.ambetterhealth.com/content/dam/centene/Nebraska/ambetter/pdf/NE_MKT_AH_26289_MetricsSummary_R.pdf", "source_segment": "w3_qhp", "extraction_note": "Issuer ID 26289; plan name printed as 'Ambetter Health', brand confirmed as Nebraska Total Care via URL path. Expedited appeals: 68 total, 30 overturned (44.12%). Expedited TAT printed in days (mean 1, median 1); converted to hours (24h/24h) - native unit was days.", "source_sha256": null, "service_list_url": null, "service_list_items": null, "entity_id": "qhp:NE:13484", "filing_unit": "qhp_issuer" }, { "filing_id": "f0136", "parent_org": "Centene", "plan_name": "Ambetter from Magnolia Health (90714)", "contract_id": "90714", "coverage_type": "Marketplace QHP", "state": "MS", "reporting_period": "CY2025", "std_total": 91950, "std_approved": 72160, "std_denied": 19790, "std_denial_rate": 21.52, "std_denial_rate_printed": null, "std_appeals_total": 1120, "std_appeals_overturned": 379, "std_appeal_overturn_rate": 33.84, "exp_total": 3356, "exp_approved": 2695, "exp_denied": 661, "exp_denial_rate": 19.7, "ext_review_approved": 603, "std_tat_mean_days": 2, "std_tat_median_days": 1, "exp_tat_mean_hours": 24, "exp_tat_median_hours": 0, "reports_counts": true, "quality_flags": "clean", "error_count": 0, "warn_count": 0, "source_url": "https://www.ambetterhealth.com/content/dam/centene/Magnolia/Ambetter/PDFs/MS_MKT_ABMagnoliaHealth_90714_MetricsSummary_R.pdf", "source_segment": "wave2", "extraction_note": "State inferred from the publishing brand page.", "source_sha256": null, "service_list_url": null, "service_list_items": null, "entity_id": "qhp:MS:90714", "filing_unit": "qhp_issuer" }, { "filing_id": "f0131", "parent_org": "Centene", "plan_name": "Ambetter from Absolute Total Care (79222)", "contract_id": "79222", "coverage_type": "Marketplace QHP", "state": "SC", "reporting_period": "CY2025", "std_total": 99318, "std_approved": 78008, "std_denied": 21310, "std_denial_rate": 21.46, "std_denial_rate_printed": null, "std_appeals_total": 1646, "std_appeals_overturned": 935, "std_appeal_overturn_rate": 56.8, "exp_total": 4020, "exp_approved": 2938, "exp_denied": 1082, "exp_denial_rate": 26.92, "ext_review_approved": 38, "std_tat_mean_days": 4, "std_tat_median_days": 1, "exp_tat_mean_hours": 24, "exp_tat_median_hours": 0, "reports_counts": true, "quality_flags": "clean", "error_count": 0, "warn_count": 0, "source_url": "https://www.ambetterhealth.com/content/dam/centene/absolute-total-care/ambetter/pdfs/SC_MKT_ABAbsoluteTotalCare_79222_MetricsSummary_R.pdf", "source_segment": "wave2", "extraction_note": "State inferred from the publishing brand page; PDF prints only 'MarketPlace'.", "source_sha256": null, "service_list_url": null, "service_list_items": null, "entity_id": "qhp:SC:79222", "filing_unit": "qhp_issuer" }, { "filing_id": "f0129", "parent_org": "Centene", "plan_name": "Ambetter Health Florida / Celtic (49004)", "contract_id": "49004", "coverage_type": "Marketplace QHP", "state": "FL", "reporting_period": "CY2025", "std_total": 419452, "std_approved": 331373, "std_denied": 88079, "std_denial_rate": 21, "std_denial_rate_printed": null, "std_appeals_total": 3670, "std_appeals_overturned": 2137, "std_appeal_overturn_rate": 58.23, "exp_total": 30415, "exp_approved": 24217, "exp_denied": 6198, "exp_denial_rate": 20.38, "ext_review_approved": 92, "std_tat_mean_days": 4, "std_tat_median_days": 0, "exp_tat_mean_hours": 24, "exp_tat_median_hours": 24, "reports_counts": true, "quality_flags": "clean", "error_count": 0, "warn_count": 0, "source_url": "https://www.ambetterhealth.com/content/dam/centene/Sunshine/Ambetter/PDFs/FL_MKT_AH_49004_MetricsSummary_R.pdf", "source_segment": "wave2", "extraction_note": "contract_id is the HIOS issuer ID. Largest marketplace filing by volume.", "source_sha256": null, "service_list_url": null, "service_list_items": null, "entity_id": "qhp:FL:49004", "filing_unit": "qhp_issuer" }, { "filing_id": "f0143", "parent_org": "Centene", "plan_name": "Ambetter of North Carolina (77264)", "contract_id": "77264", "coverage_type": "Marketplace QHP", "state": "NC", "reporting_period": "CY2025", "std_total": 50371, "std_approved": 39953, "std_denied": 10418, "std_denial_rate": 20.68, "std_denial_rate_printed": null, "std_appeals_total": 1679, "std_appeals_overturned": 870, "std_appeal_overturn_rate": 51.82, "exp_total": 1602, "exp_approved": 1215, "exp_denied": 387, "exp_denial_rate": 24.16, "ext_review_approved": 886, "std_tat_mean_days": 2, "std_tat_median_days": 1, "exp_tat_mean_hours": 24, "exp_tat_median_hours": 24, "reports_counts": true, "quality_flags": "clean", "error_count": 0, "warn_count": 0, "source_url": "https://www.ambetterhealth.com/content/dam/centene/ambetternc/pdfs/NC_MKT_ABNoCarolina_77264_MetricsSummary_R.pdf", "source_segment": "wave2", "extraction_note": "contract_id is the HIOS issuer ID.", "source_sha256": null, "service_list_url": null, "service_list_items": null, "entity_id": "qhp:NC:77264", "filing_unit": "qhp_issuer" }, { "filing_id": "f0128", "parent_org": "Centene", "plan_name": "Ambetter Health Florida (86382)", "contract_id": "86382", "coverage_type": "Marketplace QHP", "state": "FL", "reporting_period": "CY2025", "std_total": 6402, "std_approved": 5232, "std_denied": 1170, "std_denial_rate": 18.28, "std_denial_rate_printed": null, "std_appeals_total": 53, "std_appeals_overturned": 34, "std_appeal_overturn_rate": 64.15, "exp_total": 559, "exp_approved": 442, "exp_denied": 117, "exp_denial_rate": 20.93, "ext_review_approved": 3, "std_tat_mean_days": 4, "std_tat_median_days": 0, "exp_tat_mean_hours": 24, "exp_tat_median_hours": 24, "reports_counts": true, "quality_flags": "clean", "error_count": 0, "warn_count": 0, "source_url": "https://www.ambetterhealth.com/content/dam/centene/Sunshine/Ambetter/PDFs/FL_MKT_AH_86382_MetricsSummary_R.pdf", "source_segment": "wave2", "extraction_note": "contract_id is the HIOS issuer ID.", "source_sha256": null, "service_list_url": null, "service_list_items": null, "entity_id": "qhp:FL:86382", "filing_unit": "qhp_issuer" } ] }