{
    "meta": {
        "total": 5,
        "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": "f0178",
            "parent_org": "Centene",
            "plan_name": "WellCare of North Carolina",
            "contract_id": null,
            "coverage_type": "Medicaid Managed Care",
            "state": "NC",
            "reporting_period": "CY2025",
            "std_total": 146958,
            "std_approved": 124779,
            "std_denied": 22179,
            "std_denial_rate": 15.09,
            "std_denial_rate_printed": 15.09,
            "std_appeals_total": 1138,
            "std_appeals_overturned": 891,
            "std_appeal_overturn_rate": 78.3,
            "exp_total": 4346,
            "exp_approved": 4170,
            "exp_denied": 176,
            "exp_denial_rate": 4.05,
            "ext_review_approved": 74,
            "std_tat_mean_days": 5,
            "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://network.carolinacompletehealth.com/content/dam/centene/medicaid/pdfs/provider/prior-authorization-requirements-metrics/NC_WCofNC_Medicaid_180_MetricsSummary_R.pdf",
            "source_segment": "w3_ky_nc_ms_ny",
            "extraction_note": "Expedited turnaround printed as '1 days' (mean) / '0 days' (median); converted days->hours per the document's own (mislabeled-for-expedited) unit. Standard median TAT (1 day) is far below the standard mean (5 days), a skewed distribution, recorded as printed. ext_review_approved (74) is the count of standard requests the document lists as 'Approved Only After Time for Review was extended'; zero expedited requests required extended review. Document also prints expedited appeals (24 filed / 18 overturned / 75.00%) which has no dedicated field in this schema and is not stored structurally.",
            "source_sha256": null,
            "service_list_url": null,
            "service_list_items": null,
            "entity_id": "mcd:NC:wellcare",
            "filing_unit": "medicaid_plan"
        },
        {
            "filing_id": "f0014",
            "parent_org": "AmeriHealth Caritas",
            "plan_name": "AmeriHealth Caritas North Carolina",
            "contract_id": null,
            "coverage_type": "Medicaid Managed Care",
            "state": "NC",
            "reporting_period": "CY2025",
            "std_total": 77905,
            "std_approved": 65448,
            "std_denied": 11698,
            "std_denial_rate": 15.02,
            "std_denial_rate_printed": null,
            "std_appeals_total": null,
            "std_appeals_overturned": 392,
            "std_appeal_overturn_rate": null,
            "exp_total": 1410,
            "exp_approved": 1192,
            "exp_denied": 174,
            "exp_denial_rate": 12.34,
            "ext_review_approved": null,
            "std_tat_mean_days": 3.46,
            "std_tat_median_days": 1,
            "exp_tat_mean_hours": 13.96,
            "exp_tat_median_hours": 19,
            "reports_counts": true,
            "quality_flags": "error:std_counts_reconcile; error:exp_counts_reconcile",
            "error_count": 2,
            "warn_count": 0,
            "source_url": "https://www.amerihealthcaritasnc.com/member/rights/prior-authorization-reporting",
            "source_segment": "states",
            "extraction_note": "Reporting year not printed on the page. Expedited mean (13.96h) is LOWER than the expedited median (19h) as published.",
            "source_sha256": null,
            "service_list_url": null,
            "service_list_items": null,
            "entity_id": "mcd:NC:amerihealth-caritas",
            "filing_unit": "medicaid_plan"
        },
        {
            "filing_id": "f0151",
            "parent_org": "Centene",
            "plan_name": "Carolina Complete Health",
            "contract_id": null,
            "coverage_type": "Medicaid Managed Care",
            "state": "NC",
            "reporting_period": "CY2025",
            "std_total": 70843,
            "std_approved": 60830,
            "std_denied": 10013,
            "std_denial_rate": 14.13,
            "std_denial_rate_printed": 14.13,
            "std_appeals_total": 1143,
            "std_appeals_overturned": 791,
            "std_appeal_overturn_rate": 69.2,
            "exp_total": 582,
            "exp_approved": 520,
            "exp_denied": 62,
            "exp_denial_rate": 10.65,
            "ext_review_approved": null,
            "std_tat_mean_days": 5,
            "std_tat_median_days": 5,
            "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://network.carolinacompletehealth.com/content/dam/centene/medicaid/pdfs/provider/prior-authorization-requirements-metrics/NC_CCH_Medicaid_140_MetricsSummary_R.pdf",
            "source_segment": "w3_ky_nc_ms_ny",
            "extraction_note": "Document prints 'Expedited (urgent) Prior Authorization Requests ... 1 days / 1 days' for turnaround; unit is labelled 'days' even for the expedited row, so both mean and median were converted days->hours (1 day -> 24 hours) rather than left as printed-but-mislabeled. Document's own expedited-appeals row reads 'Request Approved Only After Appeal: 496 / 624 / 79.49%' — 624 expedited appeals exceeds both the 582 total expedited requests and the 62 expedited denials printed in the same filing. Recorded as printed; this is an internal self-contradiction in the payer's own numbers, not a transcription error. This schema has no dedicated expedited-appeals field, so the 624/496/79.49% figures are not stored in structured fields.",
            "source_sha256": null,
            "service_list_url": null,
            "service_list_items": null,
            "entity_id": "mcd:NC:carolina-complete-health",
            "filing_unit": "medicaid_plan"
        },
        {
            "filing_id": "f0520",
            "parent_org": "UnitedHealth Group",
            "plan_name": "North Carolina Medicaid Managed Care",
            "contract_id": null,
            "coverage_type": "Medicaid Managed Care",
            "state": "NC",
            "reporting_period": "CY2025",
            "std_total": 152752,
            "std_approved": 144090,
            "std_denied": 8662,
            "std_denial_rate": 5.67,
            "std_denial_rate_printed": null,
            "std_appeals_total": null,
            "std_appeals_overturned": 88,
            "std_appeal_overturn_rate": null,
            "exp_total": 11069,
            "exp_approved": 10286,
            "exp_denied": 783,
            "exp_denial_rate": 7.07,
            "ext_review_approved": null,
            "std_tat_mean_days": 0,
            "std_tat_median_days": 2.7,
            "exp_tat_mean_hours": 0,
            "exp_tat_median_hours": 19.2,
            "reports_counts": true,
            "quality_flags": "clean",
            "error_count": 0,
            "warn_count": 0,
            "source_url": "https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicaid-2025.pdf",
            "source_segment": "wave2",
            "extraction_note": null,
            "source_sha256": null,
            "service_list_url": null,
            "service_list_items": null,
            "entity_id": "mcd:NC:unitedhealthcare",
            "filing_unit": "medicaid_plan"
        },
        {
            "filing_id": "f0012",
            "parent_org": "Alliance Health",
            "plan_name": "Alliance Health (NC Behavioral Health I/DD Tailored Plan)",
            "contract_id": null,
            "coverage_type": "Medicaid Managed Care",
            "state": "NC",
            "reporting_period": "CY2025",
            "std_total": 97765,
            "std_approved": 95047,
            "std_denied": 2718,
            "std_denial_rate": 2.78,
            "std_denial_rate_printed": null,
            "std_appeals_total": 91,
            "std_appeals_overturned": 39,
            "std_appeal_overturn_rate": 42.86,
            "exp_total": 25962,
            "exp_approved": 25496,
            "exp_denied": 466,
            "exp_denial_rate": 1.79,
            "ext_review_approved": null,
            "std_tat_mean_days": 6.64,
            "std_tat_median_days": 7,
            "exp_tat_mean_hours": 9.48,
            "exp_tat_median_hours": 2,
            "reports_counts": true,
            "quality_flags": "clean",
            "error_count": 0,
            "warn_count": 0,
            "source_url": "https://www.alliancehealthplan.org/about/prior-authorization-metrics-for-medical-items-and-services-excluding-drugs/",
            "source_segment": "states",
            "extraction_note": "Median standard TAT (7 days) exceeds the mean (6.64), suggesting a decision cluster at the 7-day deadline.",
            "source_sha256": null,
            "service_list_url": null,
            "service_list_items": null,
            "entity_id": "mcd:NC:alliance-behavioral-healthcare",
            "filing_unit": "medicaid_plan"
        }
    ]
}