{ "meta": { "total": 13, "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": "f0068", "parent_org": "CVS Health / Aetna", "plan_name": "Aetna Better Health of New Jersey", "contract_id": "NJ-26-03-08", "coverage_type": "Medicaid Managed Care", "state": "NJ", "reporting_period": "January 1, 2025 - December 31, 2025", "std_total": 55635, "std_approved": 40306, "std_denied": 15329, "std_denial_rate": 27.55, "std_denial_rate_printed": 27.55, "std_appeals_total": 2527, "std_appeals_overturned": 380, "std_appeal_overturn_rate": 15.04, "exp_total": 11289, "exp_approved": 9780, "exp_denied": 1509, "exp_denial_rate": 13.37, "ext_review_approved": 0, "std_tat_mean_days": 8.77, "std_tat_median_days": 10, "exp_tat_mean_hours": 13.92, "exp_tat_median_hours": 0, "reports_counts": true, "quality_flags": "clean", "error_count": 0, "warn_count": 0, "source_url": "https://www.aetnabetterhealth.com/content/dam/aetna/medicaid/newjersey/providers/pdf/2025_ABHNJ_CMS_Web_Metrics-Provider_REM.pdf", "source_segment": "aetna_ahc", "extraction_note": "Expedited TAT printed in days (0.58 mean / 0.0 median); converted to hours x24. contract_id NJ-26-03-08 is printed on the document but may be a material-approval code rather than a payer contract number. Doc states 99.36% on-time.", "source_sha256": null, "service_list_url": null, "service_list_items": null, "entity_id": "mcd:NJ:aetna-better-health-nj", "filing_unit": "medicaid_plan" }, { "filing_id": "f0066", "parent_org": "CVS Health / Aetna", "plan_name": "Aetna Better Health of Maryland", "contract_id": null, "coverage_type": "Medicaid Managed Care", "state": "MD", "reporting_period": "CY2025", "std_total": 16105, "std_approved": 12367, "std_denied": 3738, "std_denial_rate": 23.21, "std_denial_rate_printed": null, "std_appeals_total": 428, "std_appeals_overturned": 78, "std_appeal_overturn_rate": 18.22, "exp_total": 1473, "exp_approved": 1023, "exp_denied": 450, "exp_denial_rate": 30.55, "ext_review_approved": 1372, "std_tat_mean_days": 1.83, "std_tat_median_days": 1, "exp_tat_mean_hours": 31.68, "exp_tat_median_hours": 24, "reports_counts": true, "quality_flags": "clean", "error_count": 0, "warn_count": 0, "source_url": "https://www.aetnabetterhealth.com/content/dam/aetna/pdfs/2025_ABHMD_CMS_Web_Metrics-Provider.pdf", "source_segment": "states", "extraction_note": "Covers Medicaid and CHIP combined. Expedited TAT published in days, x24.", "source_sha256": null, "service_list_url": null, "service_list_items": null, "entity_id": "mcd:MD:aetna-better-health-of-maryland", "filing_unit": "medicaid_plan" }, { "filing_id": "f0062", "parent_org": "CVS Health / Aetna", "plan_name": "Aetna Better Health of Florida", "contract_id": null, "coverage_type": "Medicaid Managed Care", "state": "FL", "reporting_period": "CY2025", "std_total": 43074, "std_approved": 33435, "std_denied": 9639, "std_denial_rate": 22.38, "std_denial_rate_printed": 22.38, "std_appeals_total": 1775, "std_appeals_overturned": 432, "std_appeal_overturn_rate": 24.34, "exp_total": 6500, "exp_approved": 5199, "exp_denied": 1301, "exp_denial_rate": 20.02, "ext_review_approved": 600, "std_tat_mean_days": 3.05, "std_tat_median_days": 2, "exp_tat_mean_hours": 36.48, "exp_tat_median_hours": 24, "reports_counts": true, "quality_flags": "clean", "error_count": 0, "warn_count": 0, "source_url": "https://www.aetnabetterhealth.com/content/dam/aetna/medicaid/florida/provider/pdf/2025_ABHFL_CMS_Web_Metrics_Provider_V2.pdf", "source_segment": "aetna_ahc", "extraction_note": "Expedited TAT printed in days (1.52 mean / 1 median); converted to hours x24. ext_review_approved = standard 600; expedited extended-review approved 21. Doc states 49,574 total PAs processed.", "source_sha256": null, "service_list_url": null, "service_list_items": null, "entity_id": "mcd:FL:aetna-health", "filing_unit": "medicaid_plan" }, { "filing_id": "f0067", "parent_org": "CVS Health / Aetna", "plan_name": "Aetna Better Health of Michigan", "contract_id": null, "coverage_type": "Medicaid Managed Care", "state": "MI", "reporting_period": "CY2025", "std_total": 18381, "std_approved": 14313, "std_denied": 4068, "std_denial_rate": 22.13, "std_denial_rate_printed": null, "std_appeals_total": 460, "std_appeals_overturned": 126, "std_appeal_overturn_rate": 27.39, "exp_total": 1095, "exp_approved": 893, "exp_denied": 202, "exp_denial_rate": 18.45, "ext_review_approved": 0, "std_tat_mean_days": 3.71, "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.aetnabetterhealth.com/content/dam/aetna/medicaid/michigan/pdf/abhmi_2025_cms_web_metrics_provider.pdf", "source_segment": "states", "extraction_note": "Expedited TAT published in days, x24.", "source_sha256": null, "service_list_url": null, "service_list_items": null, "entity_id": "mcd:MI:aetna-better-health-of-michigan", "filing_unit": "medicaid_plan" }, { "filing_id": "f0064", "parent_org": "CVS Health / Aetna", "plan_name": "Aetna Better Health of Kentucky", "contract_id": null, "coverage_type": "Medicaid Managed Care", "state": "KY", "reporting_period": "January 1, 2025 - December 31, 2025", "std_total": 123135, "std_approved": 99181, "std_denied": 23954, "std_denial_rate": 19.45, "std_denial_rate_printed": 19.45, "std_appeals_total": 1685, "std_appeals_overturned": 609, "std_appeal_overturn_rate": 36.14, "exp_total": 19329, "exp_approved": 16114, "exp_denied": 3215, "exp_denial_rate": 16.63, "ext_review_approved": 81, "std_tat_mean_days": 1.99, "std_tat_median_days": 2, "exp_tat_mean_hours": 38.64, "exp_tat_median_hours": 24, "reports_counts": true, "quality_flags": "clean", "error_count": 0, "warn_count": 0, "source_url": "https://www.aetnabetterhealth.com/content/dam/aetna/medicaid/kentucky/pdf/2025_ABHKY_CMS_Web_Metrics_Provider.pdf", "source_segment": "aetna_ahc", "extraction_note": "Expedited TAT printed in days (1.61 mean / 1.0 median); converted to hours x24. ext_review_approved = standard extended review 81 of 127; expedited 0 of 0.", "source_sha256": null, "service_list_url": null, "service_list_items": null, "entity_id": "mcd:KY:aetna-managed-care-organization", "filing_unit": "medicaid_plan" }, { "filing_id": "f0074", "parent_org": "CVS Health / Aetna", "plan_name": "Aetna Better Health of West Virginia", "contract_id": null, "coverage_type": "Medicaid Managed Care", "state": "WV", "reporting_period": "CY2025", "std_total": 82698, "std_approved": 66770, "std_denied": 15928, "std_denial_rate": 19.26, "std_denial_rate_printed": 19.26, "std_appeals_total": 718, "std_appeals_overturned": 185, "std_appeal_overturn_rate": 25.77, "exp_total": 1606, "exp_approved": 1314, "exp_denied": 292, "exp_denial_rate": 18.18, "ext_review_approved": 0, "std_tat_mean_days": 2.21, "std_tat_median_days": 2, "exp_tat_mean_hours": 18.48, "exp_tat_median_hours": 24, "reports_counts": true, "quality_flags": "clean", "error_count": 0, "warn_count": 0, "source_url": "https://www.aetnabetterhealth.com/content/dam/aetna/pdfs/2025_ABHWV_CMS_Web_Metrics-Provider_V2_remediated.pdf", "source_segment": "aetna_ahc", "extraction_note": "Expedited TAT printed in days (0.77 mean / 1.0 median); converted to hours x24.", "source_sha256": null, "service_list_url": null, "service_list_items": null, "entity_id": "mcd:WV:aetna-better-health-of-wv", "filing_unit": "medicaid_plan" }, { "filing_id": "abhva-2025", "parent_org": "CVS Health / Aetna", "plan_name": "Aetna Better Health of Virginia", "contract_id": null, "coverage_type": "Medicaid Managed Care", "state": "VA", "reporting_period": "CY2025", "std_total": 107984, "std_approved": 89468, "std_denied": 18516, "std_denial_rate": 17.15, "std_denial_rate_printed": null, "std_appeals_total": 3420, "std_appeals_overturned": 563, "std_appeal_overturn_rate": 16.46, "exp_total": 38417, "exp_approved": 32771, "exp_denied": 5646, "exp_denial_rate": 14.7, "ext_review_approved": 14, "std_tat_mean_days": 4.58, "std_tat_median_days": 2, "exp_tat_mean_hours": 28.92, "exp_tat_median_hours": 23, "reports_counts": true, "quality_flags": "clean", "error_count": 0, "warn_count": 0, "source_url": "https://www.aetnabetterhealth.com/content/dam/aetna/pdfs/2025_ABHVA_CMS_Web_Metrics-Member%20and%20Provider.pdf", "source_segment": "filings_2025", "extraction_note": null, "source_sha256": null, "service_list_url": null, "service_list_items": null, "entity_id": "mcd:VA:aetna-better-health-of-virginia", "filing_unit": "medicaid_plan" }, { "filing_id": "f0063", "parent_org": "CVS Health / Aetna", "plan_name": "Aetna Better Health of Illinois", "contract_id": null, "coverage_type": "Medicaid Managed Care", "state": "IL", "reporting_period": "CY2025", "std_total": 110555, "std_approved": 93277, "std_denied": 17278, "std_denial_rate": 15.63, "std_denial_rate_printed": null, "std_appeals_total": 3284, "std_appeals_overturned": 432, "std_appeal_overturn_rate": 13.15, "exp_total": 5187, "exp_approved": 4258, "exp_denied": 929, "exp_denial_rate": 17.91, "ext_review_approved": 1562, "std_tat_mean_days": 1.28, "std_tat_median_days": 1, "exp_tat_mean_hours": 20.88, "exp_tat_median_hours": 24, "reports_counts": true, "quality_flags": "clean", "error_count": 0, "warn_count": 0, "source_url": "https://www.aetnabetterhealth.com/content/dam/aetna/medicaid/illinois/providers/pdf/2025_ABHIL_CMS_Web_Metrics-Provider.pdf", "source_segment": "wave2", "extraction_note": "Expedited TAT converted days->hours; median exceeds mean as printed.", "source_sha256": null, "service_list_url": null, "service_list_items": null, "entity_id": "mcd:IL:aetna-better-health", "filing_unit": "medicaid_plan" }, { "filing_id": "f0065", "parent_org": "CVS Health / Aetna", "plan_name": "Aetna Better Health of Louisiana", "contract_id": null, "coverage_type": "Medicaid Managed Care", "state": "LA", "reporting_period": "CY2025", "std_total": 79506, "std_approved": 67439, "std_denied": 12067, "std_denial_rate": 15.18, "std_denial_rate_printed": 15.18, "std_appeals_total": 556, "std_appeals_overturned": 164, "std_appeal_overturn_rate": 29.5, "exp_total": 2062, "exp_approved": 1596, "exp_denied": 466, "exp_denial_rate": 22.6, "ext_review_approved": 58, "std_tat_mean_days": 2.29, "std_tat_median_days": 2, "exp_tat_mean_hours": 22.32, "exp_tat_median_hours": 24, "reports_counts": true, "quality_flags": "clean", "error_count": 0, "warn_count": 0, "source_url": "https://www.aetnabetterhealth.com/content/dam/aetna/medicaid/louisiana/providers/pdf/2025_ABHLA_CMS_Web_Metrics-Provider.pdf", "source_segment": "aetna_ahc", "extraction_note": "Expedited TAT printed in days (0.93 mean / 1.0 median); converted to hours x24. ext_review_approved = standard extended review 58 of 102; expedited 28 of 42. Doc also states 81,568 total PAs processed and 99.66% on-time.", "source_sha256": null, "service_list_url": null, "service_list_items": null, "entity_id": "mcd:LA:aetna-better-health-of-louisiana", "filing_unit": "medicaid_plan" }, { "filing_id": "f0070", "parent_org": "CVS Health / Aetna", "plan_name": "Aetna Better Health of Ohio (OhioRISE)", "contract_id": null, "coverage_type": "Medicaid Managed Care", "state": "OH", "reporting_period": "CY2025", "std_total": 76069, "std_approved": 65344, "std_denied": 10725, "std_denial_rate": 14.1, "std_denial_rate_printed": null, "std_appeals_total": 309, "std_appeals_overturned": 159, "std_appeal_overturn_rate": 51.46, "exp_total": 13960, "exp_approved": 13908, "exp_denied": 52, "exp_denial_rate": 0.37, "ext_review_approved": 0, "std_tat_mean_days": 4, "std_tat_median_days": 3, "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://dam.assets.ohio.gov/image/upload/medicaid.ohio.gov/Providers/Billing/PriorAuthorization/OhioRise-FinalPDF.pdf", "source_segment": "states", "extraction_note": "Expedited percentages print as 100%/0% despite 52 denials (rounding).", "source_sha256": null, "service_list_url": null, "service_list_items": null, "entity_id": "mcd:OH:aetna", "filing_unit": "medicaid_plan" }, { "filing_id": "f0071", "parent_org": "CVS Health / Aetna", "plan_name": "Aetna Better Health of Oklahoma", "contract_id": null, "coverage_type": "Medicaid Managed Care", "state": "OK", "reporting_period": "CY2025", "std_total": 64295, "std_approved": 57340, "std_denied": 6955, "std_denial_rate": 10.82, "std_denial_rate_printed": null, "std_appeals_total": 1594, "std_appeals_overturned": 288, "std_appeal_overturn_rate": 18.07, "exp_total": 1354, "exp_approved": 1055, "exp_denied": 299, "exp_denial_rate": 22.08, "ext_review_approved": 2026, "std_tat_mean_days": 1.91, "std_tat_median_days": 2, "exp_tat_mean_hours": 21.6, "exp_tat_median_hours": 24, "reports_counts": true, "quality_flags": "clean", "error_count": 0, "warn_count": 0, "source_url": "https://www.aetnabetterhealth.com/content/dam/aetna/medicaid/oklahoma/pdf/2025_ABHOK_CMS_Web_Metrics_Provider.pdf", "source_segment": "states", "extraction_note": "Standard mean TAT (1.91d) is below the median (2.0d) as published.", "source_sha256": null, "service_list_url": null, "service_list_items": null, "entity_id": "mcd:OK:aetna-better-health-of-oklahoma", "filing_unit": "medicaid_plan" }, { "filing_id": "f0069", "parent_org": "CVS Health / Aetna", "plan_name": "Aetna Better Health of New York", "contract_id": null, "coverage_type": "Medicaid Managed Care", "state": "NY", "reporting_period": "January 1, 2025 - December 31, 2025", "std_total": 53324, "std_approved": 48093, "std_denied": 5321, "std_denial_rate": 9.98, "std_denial_rate_printed": 9.81, "std_appeals_total": 243, "std_appeals_overturned": 6, "std_appeal_overturn_rate": 2.47, "exp_total": 19, "exp_approved": 4, "exp_denied": 15, "exp_denial_rate": 78.95, "ext_review_approved": 0, "std_tat_mean_days": 1.28, "std_tat_median_days": 0, "exp_tat_mean_hours": 4.56, "exp_tat_median_hours": 0, "reports_counts": true, "quality_flags": "clean", "error_count": 0, "warn_count": 0, "source_url": "https://www.aetnabetterhealth.com/content/dam/aetna/medicaid/newyork/pdf/2025_ABHNY_CMS_Web_Metrics-ProviderMember.pdf", "source_segment": "aetna_ahc", "extraction_note": "Expedited TAT printed in days (0.19 mean / 0 median); converted to hours x24. RECONCILIATION FLAG: printed approved 48,093 + denied 5,321 = 53,414, exceeding the printed standard total of 53,324 by 90. Values transcribed as printed.", "source_sha256": null, "service_list_url": null, "service_list_items": null, "entity_id": "mcd:NY:aetna-better-health", "filing_unit": "medicaid_plan" }, { "filing_id": "f0072", "parent_org": "CVS Health / Aetna", "plan_name": "Aetna Better Health of Texas", "contract_id": null, "coverage_type": "Medicaid Managed Care", "state": "TX", "reporting_period": "January 1, 2025 - December 31, 2025", "std_total": 41416, "std_approved": 38229, "std_denied": 3187, "std_denial_rate": 7.7, "std_denial_rate_printed": 7.7, "std_appeals_total": 448, "std_appeals_overturned": 162, "std_appeal_overturn_rate": 36.16, "exp_total": 1972, "exp_approved": 1827, "exp_denied": 145, "exp_denial_rate": 7.35, "ext_review_approved": 2977, "std_tat_mean_days": 3.4, "std_tat_median_days": 3, "exp_tat_mean_hours": 43.92, "exp_tat_median_hours": 24, "reports_counts": true, "quality_flags": "clean", "error_count": 0, "warn_count": 0, "source_url": "https://www.aetnabetterhealth.com/content/dam/aetna/pdfs/2025_ABHTX_CMS_Web_Metrics-Provider.pdf", "source_segment": "aetna_ahc", "extraction_note": "Expedited TAT printed in days (1.83 mean / 1.0 median); converted to hours x24. ext_review_approved is standard-request extended-review approvals (2,977 of 4,027); expedited extended-review approvals were 148 of 206. Appeal overturn pct not printed.", "source_sha256": null, "service_list_url": null, "service_list_items": null, "entity_id": "mcd:TX:aetna-better-health-of-texas", "filing_unit": "medicaid_plan" } ] }