{
    "meta": {
        "total": 3,
        "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": "f0418",
            "parent_org": "Network Health (Wisconsin)",
            "plan_name": "Network Health ACA/exchange plans",
            "contract_id": null,
            "coverage_type": "Marketplace QHP",
            "state": "WI",
            "reporting_period": "CY2025",
            "std_total": 11043,
            "std_approved": 9509,
            "std_denied": 1534,
            "std_denial_rate": 13.89,
            "std_denial_rate_printed": null,
            "std_appeals_total": 17,
            "std_appeals_overturned": 10,
            "std_appeal_overturn_rate": 58.82,
            "exp_total": 415,
            "exp_approved": 316,
            "exp_denied": 99,
            "exp_denial_rate": 23.86,
            "ext_review_approved": 0,
            "std_tat_mean_days": 4,
            "std_tat_median_days": 1.5,
            "exp_tat_mean_hours": 48,
            "exp_tat_median_hours": 36,
            "reports_counts": true,
            "quality_flags": "clean",
            "error_count": 0,
            "warn_count": 0,
            "source_url": "https://networkhealth.com/__assets/pdf/provider-resources/prior-authorization-metrics-reporting-overview-template_aca.pdf",
            "source_segment": "regional",
            "extraction_note": "Expedited denial rate (24%) is roughly double the standard rate, the reverse of the usual pattern.",
            "source_sha256": null,
            "service_list_url": null,
            "service_list_items": null,
            "entity_id": null,
            "filing_unit": null
        },
        {
            "filing_id": "f0255",
            "parent_org": "HealthPartners",
            "plan_name": "HealthPartners Commercial Wisconsin Federally Facilitated Exchange (on-exchange QHP) plans",
            "contract_id": null,
            "coverage_type": "Marketplace QHP",
            "state": "WI",
            "reporting_period": "CY2025 (January 1, 2025 - December 31, 2025)",
            "std_total": 1172,
            "std_approved": 1011,
            "std_denied": 161,
            "std_denial_rate": 13.74,
            "std_denial_rate_printed": 14,
            "std_appeals_total": 19,
            "std_appeals_overturned": 16,
            "std_appeal_overturn_rate": 84.21,
            "exp_total": 108,
            "exp_approved": 92,
            "exp_denied": 16,
            "exp_denial_rate": 14.81,
            "ext_review_approved": null,
            "std_tat_mean_days": 4,
            "std_tat_median_days": 0,
            "exp_tat_mean_hours": 21.68,
            "exp_tat_median_hours": 0.72,
            "reports_counts": true,
            "quality_flags": "clean",
            "error_count": 0,
            "warn_count": 0,
            "source_url": "https://www.healthpartners.com/content/dam/corporate/integrity-compliance/pa-reporting-cy2025-ma-medadv-msho-indwionexch.pdf",
            "source_segment": "w3_midwest",
            "extraction_note": "Document labels this line 'QHP issuers on the FFEs (HealthPartners Commercial WI Federally Facilitated Exchange Products)'. Expedited appeals reported separately (1 total, 0 overturned) but no exp_appeals field exists in this schema; noted here only.",
            "source_sha256": null,
            "service_list_url": null,
            "service_list_items": null,
            "entity_id": "qhp:WI:20173",
            "filing_unit": "qhp_issuer"
        },
        {
            "filing_id": "f0244",
            "parent_org": "Group Health Cooperative of South Central Wisconsin",
            "plan_name": "GHC-SCW Qualified Health Plan (Marketplace)",
            "contract_id": null,
            "coverage_type": "Marketplace QHP",
            "state": "WI",
            "reporting_period": "CY2025 (Jan 1 - Dec 31, 2025)",
            "std_total": null,
            "std_approved": null,
            "std_denied": null,
            "std_denial_rate": 3,
            "std_denial_rate_printed": 3,
            "std_appeals_total": 4,
            "std_appeals_overturned": null,
            "std_appeal_overturn_rate": 25,
            "exp_total": null,
            "exp_approved": null,
            "exp_denied": null,
            "exp_denial_rate": 3,
            "ext_review_approved": null,
            "std_tat_mean_days": 1,
            "std_tat_median_days": 0,
            "exp_tat_mean_hours": 4.8,
            "exp_tat_median_hours": 0,
            "reports_counts": false,
            "quality_flags": "info:percentages_only",
            "error_count": 0,
            "warn_count": 0,
            "source_url": "https://ghcscw.com/wp-content/uploads/2026/02/MK26-9-02.26FL_Prior-Authorization-Summary-Flier_2025_V1.pdf",
            "source_segment": "w3_midwest",
            "extraction_note": "Percentages only (97%/3% standard, 97%/3% urgent) -- reports_counts=false, no counts recorded. Document prints a footnote that only 4 appeals total occurred in this line ('*Only had 4 appeals in these categories') with 25% approved / 75% denied after appeal -- recorded std_appeals_total=4 and std_appeal_overturn_pct=25 as printed; did NOT compute the corresponding overturned headcount (would require multiplying 25%x4, which is a derived number, not a transcribed one). Document explicitly labels expedited/urgent TAT in days (0.2 mean / 0 median); converted to hours per brief instructions (0.2*24=4.8, 0*24=0) and flagged as a conversion.",
            "source_sha256": null,
            "service_list_url": null,
            "service_list_items": null,
            "entity_id": null,
            "filing_unit": null
        }
    ]
}