{ "meta": { "total": 54, "page": 1, "per_page": 50, "pages": 2, "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": "f0063", "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." }, { "filing_id": "f0061", "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." }, { "filing_id": "f0057", "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." }, { "filing_id": "f0062", "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." }, { "filing_id": "f0059", "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." }, { "filing_id": "f0069", "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." }, { "filing_id": "f0054", "parent_org": "CVS Health / Aetna", "plan_name": "Aetna Better Health Kids (Pennsylvania CHIP)", "contract_id": null, "coverage_type": "CHIP Managed Care", "state": "PA", "reporting_period": "CY2025", "std_total": 2066, "std_approved": 1695, "std_denied": 371, "std_denial_rate": 17.96, "std_denial_rate_printed": null, "std_appeals_total": 153, "std_appeals_overturned": 68, "std_appeal_overturn_rate": 44.44, "exp_total": 2990, "exp_approved": 2445, "exp_denied": 545, "exp_denial_rate": 18.23, "ext_review_approved": 23, "std_tat_mean_days": 1.97, "std_tat_median_days": 1, "exp_tat_mean_hours": 51.12, "exp_tat_median_hours": 48, "reports_counts": true, "quality_flags": "warn:expedited_slower_than_standard; warn:expedited_exceeds_standard_volume", "error_count": 0, "warn_count": 2, "source_url": "https://www.aetnabetterhealth.com/content/dam/aetna/pdfs/2025_ABHPA%20CHIP_CMS_Web_Metrics-Provider.pdf", "source_segment": "states", "extraction_note": "State inferred from the filename token, not printed in the document body. Expedited volume (2,990) exceeds standard (2,066)." }, { "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 }, { "filing_id": "f0096", "parent_org": "CVS Health / Aetna", "plan_name": "Aetna Medicare Advantage - contract H5309", "contract_id": "H5309", "coverage_type": "Medicare Advantage", "state": null, "reporting_period": "CY2025", "std_total": null, "std_approved": null, "std_denied": null, "std_denial_rate": 16.34, "std_denial_rate_printed": 16.34, "std_appeals_total": null, "std_appeals_overturned": null, "std_appeal_overturn_rate": 95.37, "exp_total": null, "exp_approved": null, "exp_denied": null, "exp_denial_rate": 24.73, "ext_review_approved": null, "std_tat_mean_days": 2.71, "std_tat_median_days": 0, "exp_tat_mean_hours": 7.92, "exp_tat_median_hours": 0, "reports_counts": false, "quality_flags": "info:appeals_not_reported; info:percentages_only", "error_count": 0, "warn_count": 0, "source_url": "https://www.aetna.com/content/dam/aetna/pdfs/wwwaetnamedicarecomSSL/individual/website/2025_PA_Metric_Report.pdf", "source_segment": "w3_gaps_b", "extraction_note": "Continuation of the previously-captured 26-contract Aetna Medicare filing (H0523-H5302), which the recorded gap flagged as truncated after H5302. Re-fetched narrowly and confirmed the document continues with 11 more contracts (H5309 through H8597) before actually ending. This document reports only percentages, no raw counts. It labels both standard AND expedited turnaround as 'day(s)' explicitly; expedited mean/median converted days->hours (x24) per schema; standard left in days as printed." }, { "filing_id": "f0058", "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." }, { "filing_id": "f0060", "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." }, { "filing_id": "f0065", "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)." }, { "filing_id": "f0105", "parent_org": "CVS Health / Aetna", "plan_name": "Aetna Medicare Advantage - contract H8332", "contract_id": "H8332", "coverage_type": "Medicare Advantage", "state": null, "reporting_period": "CY2025", "std_total": null, "std_approved": null, "std_denied": null, "std_denial_rate": 13.18, "std_denial_rate_printed": 13.18, "std_appeals_total": null, "std_appeals_overturned": null, "std_appeal_overturn_rate": 72.22, "exp_total": null, "exp_approved": null, "exp_denied": null, "exp_denial_rate": 15.69, "ext_review_approved": null, "std_tat_mean_days": 1.46, "std_tat_median_days": 0, "exp_tat_mean_hours": 10.32, "exp_tat_median_hours": 0, "reports_counts": false, "quality_flags": "info:appeals_not_reported; info:percentages_only", "error_count": 0, "warn_count": 0, "source_url": "https://www.aetna.com/content/dam/aetna/pdfs/wwwaetnamedicarecomSSL/individual/website/2025_PA_Metric_Report.pdf", "source_segment": "w3_gaps_b", "extraction_note": "Part of the previously-truncated Aetna Medicare consolidated PDF, contract following H5302. Percentages only. Expedited TAT converted days->hours (document labels both standard and expedited turnaround in days)." }, { "filing_id": "f0091", "parent_org": "CVS Health / Aetna", "plan_name": "Aetna Medicare Advantage - contract H4523", "contract_id": "H4523", "coverage_type": "Medicare Advantage", "state": null, "reporting_period": "2025", "std_total": null, "std_approved": null, "std_denied": null, "std_denial_rate": 12.73, "std_denial_rate_printed": 12.73, "std_appeals_total": null, "std_appeals_overturned": null, "std_appeal_overturn_rate": 88.96, "exp_total": null, "exp_approved": null, "exp_denied": null, "exp_denial_rate": 16.44, "ext_review_approved": null, "std_tat_mean_days": 1.8, "std_tat_median_days": 0, "exp_tat_mean_hours": 7.92, "exp_tat_median_hours": 0, "reports_counts": false, "quality_flags": "info:appeals_not_reported; info:percentages_only", "error_count": 0, "warn_count": 0, "source_url": "https://www.aetna.com/content/dam/aetna/pdfs/wwwaetnamedicarecomSSL/individual/website/2025_PA_Metric_Report.pdf", "source_segment": "aetna_ahc", "extraction_note": "Consolidated Aetna MA CMS-0057-F disclosure; percentages and mean/median days only, no raw counts. Expedited TAT converted from days to hours x24. State not printed." }, { "filing_id": "f0082", "parent_org": "CVS Health / Aetna", "plan_name": "Aetna Medicare Advantage - contract H3219", "contract_id": "H3219", "coverage_type": "Medicare Advantage", "state": null, "reporting_period": "2025", "std_total": null, "std_approved": null, "std_denied": null, "std_denial_rate": 11.47, "std_denial_rate_printed": 11.47, "std_appeals_total": null, "std_appeals_overturned": null, "std_appeal_overturn_rate": 80.43, "exp_total": null, "exp_approved": null, "exp_denied": null, "exp_denial_rate": 13.14, "ext_review_approved": null, "std_tat_mean_days": 2.28, "std_tat_median_days": 1, "exp_tat_mean_hours": 15.6, "exp_tat_median_hours": 0, "reports_counts": false, "quality_flags": "info:appeals_not_reported; info:percentages_only", "error_count": 0, "warn_count": 0, "source_url": "https://www.aetna.com/content/dam/aetna/pdfs/wwwaetnamedicarecomSSL/individual/website/2025_PA_Metric_Report.pdf", "source_segment": "aetna_ahc", "extraction_note": "Consolidated Aetna MA CMS-0057-F disclosure; percentages and mean/median days only, no raw counts. Expedited TAT converted from days to hours x24. State not printed." }, { "filing_id": "f0092", "parent_org": "CVS Health / Aetna", "plan_name": "Aetna Medicare Advantage - contract H4711", "contract_id": "H4711", "coverage_type": "Medicare Advantage", "state": null, "reporting_period": "2025", "std_total": null, "std_approved": null, "std_denied": null, "std_denial_rate": 11.3, "std_denial_rate_printed": 11.3, "std_appeals_total": null, "std_appeals_overturned": null, "std_appeal_overturn_rate": 86.71, "exp_total": null, "exp_approved": null, "exp_denied": null, "exp_denial_rate": 14.79, "ext_review_approved": null, "std_tat_mean_days": 1.93, "std_tat_median_days": 0, "exp_tat_mean_hours": 9.12, "exp_tat_median_hours": 0, "reports_counts": false, "quality_flags": "info:appeals_not_reported; info:percentages_only", "error_count": 0, "warn_count": 0, "source_url": "https://www.aetna.com/content/dam/aetna/pdfs/wwwaetnamedicarecomSSL/individual/website/2025_PA_Metric_Report.pdf", "source_segment": "aetna_ahc", "extraction_note": "Consolidated Aetna MA CMS-0057-F disclosure; percentages and mean/median days only, no raw counts. Expedited TAT converted from days to hours x24. State not printed." }, { "filing_id": "f0084", "parent_org": "CVS Health / Aetna", "plan_name": "Aetna Medicare Advantage - contract H3288", "contract_id": "H3288", "coverage_type": "Medicare Advantage", "state": null, "reporting_period": "2025", "std_total": null, "std_approved": null, "std_denied": null, "std_denial_rate": 10.94, "std_denial_rate_printed": 10.94, "std_appeals_total": null, "std_appeals_overturned": null, "std_appeal_overturn_rate": 90.48, "exp_total": null, "exp_approved": null, "exp_denied": null, "exp_denial_rate": 14.53, "ext_review_approved": null, "std_tat_mean_days": 1.66, "std_tat_median_days": 0, "exp_tat_mean_hours": 9.84, "exp_tat_median_hours": 0, "reports_counts": false, "quality_flags": "info:appeals_not_reported; info:percentages_only", "error_count": 0, "warn_count": 0, "source_url": "https://www.aetna.com/content/dam/aetna/pdfs/wwwaetnamedicarecomSSL/individual/website/2025_PA_Metric_Report.pdf", "source_segment": "aetna_ahc", "extraction_note": "Consolidated Aetna MA CMS-0057-F disclosure; percentages and mean/median days only, no raw counts. Expedited TAT converted from days to hours x24. State not printed." }, { "filing_id": "f0066", "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." }, { "filing_id": "f0093", "parent_org": "CVS Health / Aetna", "plan_name": "Aetna Medicare Advantage - contract H4835", "contract_id": "H4835", "coverage_type": "Medicare Advantage", "state": null, "reporting_period": "2025", "std_total": null, "std_approved": null, "std_denied": null, "std_denial_rate": 10.69, "std_denial_rate_printed": 10.69, "std_appeals_total": null, "std_appeals_overturned": null, "std_appeal_overturn_rate": 88.46, "exp_total": null, "exp_approved": null, "exp_denied": null, "exp_denial_rate": 19.26, "ext_review_approved": null, "std_tat_mean_days": 1.81, "std_tat_median_days": 0, "exp_tat_mean_hours": 11.28, "exp_tat_median_hours": 0, "reports_counts": false, "quality_flags": "info:appeals_not_reported; info:percentages_only", "error_count": 0, "warn_count": 0, "source_url": "https://www.aetna.com/content/dam/aetna/pdfs/wwwaetnamedicarecomSSL/individual/website/2025_PA_Metric_Report.pdf", "source_segment": "aetna_ahc", "extraction_note": "Consolidated Aetna MA CMS-0057-F disclosure; percentages and mean/median days only, no raw counts. Expedited TAT converted from days to hours x24. State not printed." }, { "filing_id": "f0088", "parent_org": "CVS Health / Aetna", "plan_name": "Aetna Medicare Advantage - contract H3928", "contract_id": "H3928", "coverage_type": "Medicare Advantage", "state": null, "reporting_period": "2025", "std_total": null, "std_approved": null, "std_denied": null, "std_denial_rate": 10.42, "std_denial_rate_printed": 10.42, "std_appeals_total": null, "std_appeals_overturned": null, "std_appeal_overturn_rate": 87.1, "exp_total": null, "exp_approved": null, "exp_denied": null, "exp_denial_rate": 18.57, "ext_review_approved": null, "std_tat_mean_days": 1.54, "std_tat_median_days": 0, "exp_tat_mean_hours": 10.32, "exp_tat_median_hours": 0, "reports_counts": false, "quality_flags": "info:appeals_not_reported; info:percentages_only", "error_count": 0, "warn_count": 0, "source_url": "https://www.aetna.com/content/dam/aetna/pdfs/wwwaetnamedicarecomSSL/individual/website/2025_PA_Metric_Report.pdf", "source_segment": "aetna_ahc", "extraction_note": "Consolidated Aetna MA CMS-0057-F disclosure; percentages and mean/median days only, no raw counts. Expedited TAT converted from days to hours x24. State not printed." }, { "filing_id": "f0083", "parent_org": "CVS Health / Aetna", "plan_name": "Aetna Medicare Advantage - contract H3239", "contract_id": "H3239", "coverage_type": "Medicare Advantage", "state": null, "reporting_period": "2025", "std_total": null, "std_approved": null, "std_denied": null, "std_denial_rate": 10.41, "std_denial_rate_printed": 10.41, "std_appeals_total": null, "std_appeals_overturned": null, "std_appeal_overturn_rate": 84.71, "exp_total": null, "exp_approved": null, "exp_denied": null, "exp_denial_rate": 14.68, "ext_review_approved": null, "std_tat_mean_days": 1.69, "std_tat_median_days": 0, "exp_tat_mean_hours": 9.12, "exp_tat_median_hours": 0, "reports_counts": false, "quality_flags": "info:appeals_not_reported; info:percentages_only", "error_count": 0, "warn_count": 0, "source_url": "https://www.aetna.com/content/dam/aetna/pdfs/wwwaetnamedicarecomSSL/individual/website/2025_PA_Metric_Report.pdf", "source_segment": "aetna_ahc", "extraction_note": "Consolidated Aetna MA CMS-0057-F disclosure; percentages and mean/median days only, no raw counts. Expedited TAT converted from days to hours x24. State not printed." }, { "filing_id": "f0076", "parent_org": "CVS Health / Aetna", "plan_name": "Aetna Medicare Advantage - contract H1609", "contract_id": "H1609", "coverage_type": "Medicare Advantage", "state": null, "reporting_period": "2025", "std_total": null, "std_approved": null, "std_denied": null, "std_denial_rate": 10.36, "std_denial_rate_printed": 10.36, "std_appeals_total": null, "std_appeals_overturned": null, "std_appeal_overturn_rate": 83.79, "exp_total": null, "exp_approved": null, "exp_denied": null, "exp_denial_rate": 11.78, "ext_review_approved": null, "std_tat_mean_days": 1.5, "std_tat_median_days": 0, "exp_tat_mean_hours": 6, "exp_tat_median_hours": 0, "reports_counts": false, "quality_flags": "info:appeals_not_reported; info:percentages_only", "error_count": 0, "warn_count": 0, "source_url": "https://www.aetna.com/content/dam/aetna/pdfs/wwwaetnamedicarecomSSL/individual/website/2025_PA_Metric_Report.pdf", "source_segment": "aetna_ahc", "extraction_note": "Consolidated Aetna MA CMS-0057-F disclosure; percentages and mean/median days only, no raw counts. Expedited TAT converted from days to hours x24. State not printed." }, { "filing_id": "f0064", "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." }, { "filing_id": "f0077", "parent_org": "CVS Health / Aetna", "plan_name": "Aetna Medicare Advantage - contract H1692", "contract_id": "H1692", "coverage_type": "Medicare Advantage", "state": null, "reporting_period": "2025", "std_total": null, "std_approved": null, "std_denied": null, "std_denial_rate": 9.59, "std_denial_rate_printed": 9.59, "std_appeals_total": null, "std_appeals_overturned": null, "std_appeal_overturn_rate": 90.69, "exp_total": null, "exp_approved": null, "exp_denied": null, "exp_denial_rate": 16.47, "ext_review_approved": null, "std_tat_mean_days": 1.47, "std_tat_median_days": 0, "exp_tat_mean_hours": 8.88, "exp_tat_median_hours": 0, "reports_counts": false, "quality_flags": "info:appeals_not_reported; info:percentages_only", "error_count": 0, "warn_count": 0, "source_url": "https://www.aetna.com/content/dam/aetna/pdfs/wwwaetnamedicarecomSSL/individual/website/2025_PA_Metric_Report.pdf", "source_segment": "aetna_ahc", "extraction_note": "Consolidated Aetna MA CMS-0057-F disclosure; percentages and mean/median days only, no raw counts. Expedited TAT converted from days to hours x24. State not printed." }, { "filing_id": "f0089", "parent_org": "CVS Health / Aetna", "plan_name": "Aetna Medicare Advantage - contract H3931", "contract_id": "H3931", "coverage_type": "Medicare Advantage", "state": null, "reporting_period": "2025", "std_total": null, "std_approved": null, "std_denied": null, "std_denial_rate": 9.5, "std_denial_rate_printed": 9.5, "std_appeals_total": null, "std_appeals_overturned": null, "std_appeal_overturn_rate": 87.93, "exp_total": null, "exp_approved": null, "exp_denied": null, "exp_denial_rate": 14.97, "ext_review_approved": null, "std_tat_mean_days": 1.68, "std_tat_median_days": 0, "exp_tat_mean_hours": 9.84, "exp_tat_median_hours": 0, "reports_counts": false, "quality_flags": "info:appeals_not_reported; info:percentages_only", "error_count": 0, "warn_count": 0, "source_url": "https://www.aetna.com/content/dam/aetna/pdfs/wwwaetnamedicarecomSSL/individual/website/2025_PA_Metric_Report.pdf", "source_segment": "aetna_ahc", "extraction_note": "Consolidated Aetna MA CMS-0057-F disclosure; percentages and mean/median days only, no raw counts. Expedited TAT converted from days to hours x24. State not printed." }, { "filing_id": "f0097", "parent_org": "CVS Health / Aetna", "plan_name": "Aetna Medicare Advantage - contract H5325", "contract_id": "H5325", "coverage_type": "Medicare Advantage", "state": null, "reporting_period": "CY2025", "std_total": null, "std_approved": null, "std_denied": null, "std_denial_rate": 8.68, "std_denial_rate_printed": 8.68, "std_appeals_total": null, "std_appeals_overturned": null, "std_appeal_overturn_rate": 83.73, "exp_total": null, "exp_approved": null, "exp_denied": null, "exp_denial_rate": 13.18, "ext_review_approved": null, "std_tat_mean_days": 1.47, "std_tat_median_days": 0, "exp_tat_mean_hours": 7.92, "exp_tat_median_hours": 0, "reports_counts": false, "quality_flags": "info:appeals_not_reported; info:percentages_only", "error_count": 0, "warn_count": 0, "source_url": "https://www.aetna.com/content/dam/aetna/pdfs/wwwaetnamedicarecomSSL/individual/website/2025_PA_Metric_Report.pdf", "source_segment": "w3_gaps_b", "extraction_note": "Part of the previously-truncated Aetna Medicare consolidated PDF, contract following H5302. Percentages only. Expedited TAT converted days->hours (document labels both standard and expedited turnaround in days)." }, { "filing_id": "f0079", "parent_org": "CVS Health / Aetna", "plan_name": "Aetna Medicare Advantage - contract H2293", "contract_id": "H2293", "coverage_type": "Medicare Advantage", "state": null, "reporting_period": "2025", "std_total": null, "std_approved": null, "std_denied": null, "std_denial_rate": 8.29, "std_denial_rate_printed": 8.29, "std_appeals_total": null, "std_appeals_overturned": null, "std_appeal_overturn_rate": 88.86, "exp_total": null, "exp_approved": null, "exp_denied": null, "exp_denial_rate": 14.6, "ext_review_approved": null, "std_tat_mean_days": 1.53, "std_tat_median_days": 0, "exp_tat_mean_hours": 7.68, "exp_tat_median_hours": 0, "reports_counts": false, "quality_flags": "info:appeals_not_reported; info:percentages_only", "error_count": 0, "warn_count": 0, "source_url": "https://www.aetna.com/content/dam/aetna/pdfs/wwwaetnamedicarecomSSL/individual/website/2025_PA_Metric_Report.pdf", "source_segment": "aetna_ahc", "extraction_note": "Consolidated Aetna MA CMS-0057-F disclosure; percentages and mean/median days only, no raw counts. Expedited TAT converted from days to hours x24. State not printed." }, { "filing_id": "f0075", "parent_org": "CVS Health / Aetna", "plan_name": "Aetna Medicare Advantage - contract H1608", "contract_id": "H1608", "coverage_type": "Medicare Advantage", "state": null, "reporting_period": "2025", "std_total": null, "std_approved": null, "std_denied": null, "std_denial_rate": 8.17, "std_denial_rate_printed": 8.17, "std_appeals_total": null, "std_appeals_overturned": null, "std_appeal_overturn_rate": 92.4, "exp_total": null, "exp_approved": null, "exp_denied": null, "exp_denial_rate": 12.54, "ext_review_approved": null, "std_tat_mean_days": 1.45, "std_tat_median_days": 0, "exp_tat_mean_hours": 7.92, "exp_tat_median_hours": 0, "reports_counts": false, "quality_flags": "info:appeals_not_reported; info:percentages_only", "error_count": 0, "warn_count": 0, "source_url": "https://www.aetna.com/content/dam/aetna/pdfs/wwwaetnamedicarecomSSL/individual/website/2025_PA_Metric_Report.pdf", "source_segment": "aetna_ahc", "extraction_note": "Consolidated Aetna MA CMS-0057-F disclosure; percentages and mean/median days only, no raw counts. Expedited TAT converted from days to hours x24. State not printed." }, { "filing_id": "f0099", "parent_org": "CVS Health / Aetna", "plan_name": "Aetna Medicare Advantage - contract H5521", "contract_id": "H5521", "coverage_type": "Medicare Advantage", "state": null, "reporting_period": "CY2025", "std_total": null, "std_approved": null, "std_denied": null, "std_denial_rate": 7.86, "std_denial_rate_printed": 7.86, "std_appeals_total": null, "std_appeals_overturned": null, "std_appeal_overturn_rate": 89.7, "exp_total": null, "exp_approved": null, "exp_denied": null, "exp_denial_rate": 10.87, "ext_review_approved": null, "std_tat_mean_days": 1.44, "std_tat_median_days": 0, "exp_tat_mean_hours": 7.68, "exp_tat_median_hours": 0, "reports_counts": false, "quality_flags": "info:appeals_not_reported; info:percentages_only", "error_count": 0, "warn_count": 0, "source_url": "https://www.aetna.com/content/dam/aetna/pdfs/wwwaetnamedicarecomSSL/individual/website/2025_PA_Metric_Report.pdf", "source_segment": "w3_gaps_b", "extraction_note": "Part of the previously-truncated Aetna Medicare consolidated PDF, contract following H5302. Percentages only. Expedited TAT converted days->hours (document labels both standard and expedited turnaround in days)." }, { "filing_id": "f0103", "parent_org": "CVS Health / Aetna", "plan_name": "Aetna Medicare Advantage - contract H7149", "contract_id": "H7149", "coverage_type": "Medicare Advantage", "state": null, "reporting_period": "CY2025", "std_total": null, "std_approved": null, "std_denied": null, "std_denial_rate": 7.76, "std_denial_rate_printed": 7.76, "std_appeals_total": null, "std_appeals_overturned": null, "std_appeal_overturn_rate": 88.55, "exp_total": null, "exp_approved": null, "exp_denied": null, "exp_denial_rate": 13.09, "ext_review_approved": null, "std_tat_mean_days": 1.53, "std_tat_median_days": 0, "exp_tat_mean_hours": 9.12, "exp_tat_median_hours": 0, "reports_counts": false, "quality_flags": "info:appeals_not_reported; info:percentages_only", "error_count": 0, "warn_count": 0, "source_url": "https://www.aetna.com/content/dam/aetna/pdfs/wwwaetnamedicarecomSSL/individual/website/2025_PA_Metric_Report.pdf", "source_segment": "w3_gaps_b", "extraction_note": "Part of the previously-truncated Aetna Medicare consolidated PDF, contract following H5302. Percentages only. Expedited TAT converted days->hours (document labels both standard and expedited turnaround in days)." }, { "filing_id": "f0067", "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." }, { "filing_id": "f0072", "parent_org": "CVS Health / Aetna", "plan_name": "Aetna Medicare Advantage - contract H0628", "contract_id": "H0628", "coverage_type": "Medicare Advantage", "state": null, "reporting_period": "2025", "std_total": null, "std_approved": null, "std_denied": null, "std_denial_rate": 7.68, "std_denial_rate_printed": 7.68, "std_appeals_total": null, "std_appeals_overturned": null, "std_appeal_overturn_rate": 89.47, "exp_total": null, "exp_approved": null, "exp_denied": null, "exp_denial_rate": 13.66, "ext_review_approved": null, "std_tat_mean_days": 1.28, "std_tat_median_days": 0, "exp_tat_mean_hours": 7.68, "exp_tat_median_hours": 0, "reports_counts": false, "quality_flags": "info:appeals_not_reported; info:percentages_only", "error_count": 0, "warn_count": 0, "source_url": "https://www.aetna.com/content/dam/aetna/pdfs/wwwaetnamedicarecomSSL/individual/website/2025_PA_Metric_Report.pdf", "source_segment": "aetna_ahc", "extraction_note": "Consolidated Aetna MA CMS-0057-F disclosure; percentages and mean/median days only, no raw counts. Expedited TAT converted from days to hours x24. State not printed." }, { "filing_id": "f0073", "parent_org": "CVS Health / Aetna", "plan_name": "Aetna Medicare Advantage - contract H1109", "contract_id": "H1109", "coverage_type": "Medicare Advantage", "state": null, "reporting_period": "2025", "std_total": null, "std_approved": null, "std_denied": null, "std_denial_rate": 7.68, "std_denial_rate_printed": 7.68, "std_appeals_total": null, "std_appeals_overturned": null, "std_appeal_overturn_rate": 82.61, "exp_total": null, "exp_approved": null, "exp_denied": null, "exp_denial_rate": 6.94, "ext_review_approved": null, "std_tat_mean_days": 1.39, "std_tat_median_days": 0, "exp_tat_mean_hours": 3.36, "exp_tat_median_hours": 0, "reports_counts": false, "quality_flags": "info:appeals_not_reported; info:percentages_only", "error_count": 0, "warn_count": 0, "source_url": "https://www.aetna.com/content/dam/aetna/pdfs/wwwaetnamedicarecomSSL/individual/website/2025_PA_Metric_Report.pdf", "source_segment": "aetna_ahc", "extraction_note": "Consolidated Aetna MA CMS-0057-F disclosure; percentages and mean/median days only, no raw counts. Expedited TAT converted from days to hours x24. State not printed." }, { "filing_id": "f0095", "parent_org": "CVS Health / Aetna", "plan_name": "Aetna Medicare Advantage - contract H5302", "contract_id": "H5302", "coverage_type": "Medicare Advantage", "state": null, "reporting_period": "2025", "std_total": null, "std_approved": null, "std_denied": null, "std_denial_rate": 7.44, "std_denial_rate_printed": 7.44, "std_appeals_total": null, "std_appeals_overturned": null, "std_appeal_overturn_rate": 85.65, "exp_total": null, "exp_approved": null, "exp_denied": null, "exp_denial_rate": 13.35, "ext_review_approved": null, "std_tat_mean_days": 1.29, "std_tat_median_days": 0, "exp_tat_mean_hours": 7.2, "exp_tat_median_hours": 0, "reports_counts": false, "quality_flags": "info:appeals_not_reported; info:percentages_only", "error_count": 0, "warn_count": 0, "source_url": "https://www.aetna.com/content/dam/aetna/pdfs/wwwaetnamedicarecomSSL/individual/website/2025_PA_Metric_Report.pdf", "source_segment": "aetna_ahc", "extraction_note": "Consolidated Aetna MA CMS-0057-F disclosure; percentages and mean/median days only, no raw counts. Expedited TAT converted from days to hours x24. State not printed." }, { "filing_id": "f0085", "parent_org": "CVS Health / Aetna", "plan_name": "Aetna Medicare Advantage - contract H3312", "contract_id": "H3312", "coverage_type": "Medicare Advantage", "state": null, "reporting_period": "2025", "std_total": null, "std_approved": null, "std_denied": null, "std_denial_rate": 7.31, "std_denial_rate_printed": 7.31, "std_appeals_total": null, "std_appeals_overturned": null, "std_appeal_overturn_rate": 82.33, "exp_total": null, "exp_approved": null, "exp_denied": null, "exp_denial_rate": 14.6, "ext_review_approved": null, "std_tat_mean_days": 1.3, "std_tat_median_days": 0, "exp_tat_mean_hours": 10.8, "exp_tat_median_hours": 0, "reports_counts": false, "quality_flags": "info:appeals_not_reported; info:percentages_only", "error_count": 0, "warn_count": 0, "source_url": "https://www.aetna.com/content/dam/aetna/pdfs/wwwaetnamedicarecomSSL/individual/website/2025_PA_Metric_Report.pdf", "source_segment": "aetna_ahc", "extraction_note": "Consolidated Aetna MA CMS-0057-F disclosure; percentages and mean/median days only, no raw counts. Expedited TAT converted from days to hours x24. State not printed." }, { "filing_id": "f0087", "parent_org": "CVS Health / Aetna", "plan_name": "Aetna Medicare Advantage - contract H3748", "contract_id": "H3748", "coverage_type": "Medicare Advantage", "state": null, "reporting_period": "2025", "std_total": null, "std_approved": null, "std_denied": null, "std_denial_rate": 7.28, "std_denial_rate_printed": 7.28, "std_appeals_total": null, "std_appeals_overturned": null, "std_appeal_overturn_rate": 90.62, "exp_total": null, "exp_approved": null, "exp_denied": null, "exp_denial_rate": 8, "ext_review_approved": null, "std_tat_mean_days": 1.47, "std_tat_median_days": 0, "exp_tat_mean_hours": 4.32, "exp_tat_median_hours": 0, "reports_counts": false, "quality_flags": "info:appeals_not_reported; info:percentages_only", "error_count": 0, "warn_count": 0, "source_url": "https://www.aetna.com/content/dam/aetna/pdfs/wwwaetnamedicarecomSSL/individual/website/2025_PA_Metric_Report.pdf", "source_segment": "aetna_ahc", "extraction_note": "Consolidated Aetna MA CMS-0057-F disclosure; percentages and mean/median days only, no raw counts. Expedited TAT converted from days to hours x24. State not printed." }, { "filing_id": "f0106", "parent_org": "CVS Health / Aetna", "plan_name": "Aetna Medicare Advantage - contract H8597", "contract_id": "H8597", "coverage_type": "Medicare Advantage", "state": null, "reporting_period": "CY2025", "std_total": null, "std_approved": null, "std_denied": null, "std_denial_rate": 7.28, "std_denial_rate_printed": 7.28, "std_appeals_total": null, "std_appeals_overturned": null, "std_appeal_overturn_rate": 90.62, "exp_total": null, "exp_approved": null, "exp_denied": null, "exp_denial_rate": 8, "ext_review_approved": null, "std_tat_mean_days": 1.47, "std_tat_median_days": 0, "exp_tat_mean_hours": 4.32, "exp_tat_median_hours": 0, "reports_counts": false, "quality_flags": "info:appeals_not_reported; info:percentages_only", "error_count": 0, "warn_count": 0, "source_url": "https://www.aetna.com/content/dam/aetna/pdfs/wwwaetnamedicarecomSSL/individual/website/2025_PA_Metric_Report.pdf", "source_segment": "w3_gaps_b", "extraction_note": "Last contract in the document by repeated roster and boundary checks (H0523...H5302...H8597); no contract beyond H8597 could be found across three independently-worded fetches. 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Expedited TAT converted days->hours (document labels both standard and expedited turnaround in days)." }, { "filing_id": "f0078", "parent_org": "CVS Health / Aetna", "plan_name": "Aetna Medicare Advantage - contract H2056", "contract_id": "H2056", "coverage_type": "Medicare Advantage", "state": null, "reporting_period": "2025", "std_total": null, "std_approved": null, "std_denied": null, "std_denial_rate": 7.22, "std_denial_rate_printed": 7.22, "std_appeals_total": null, "std_appeals_overturned": null, "std_appeal_overturn_rate": 88.46, "exp_total": null, "exp_approved": null, "exp_denied": null, "exp_denial_rate": 9.65, "ext_review_approved": null, "std_tat_mean_days": 1.5, "std_tat_median_days": 0, "exp_tat_mean_hours": 9.12, "exp_tat_median_hours": 0, "reports_counts": false, "quality_flags": "info:appeals_not_reported; info:percentages_only", "error_count": 0, "warn_count": 0, "source_url": "https://www.aetna.com/content/dam/aetna/pdfs/wwwaetnamedicarecomSSL/individual/website/2025_PA_Metric_Report.pdf", "source_segment": "aetna_ahc", "extraction_note": "Consolidated Aetna MA CMS-0057-F disclosure; percentages and mean/median days only, no raw counts. Expedited TAT converted from days to hours x24. State not printed." }, { "filing_id": "f0081", "parent_org": "CVS Health / Aetna", "plan_name": "Aetna Medicare Advantage - contract H3146", "contract_id": "H3146", "coverage_type": "Medicare Advantage", "state": null, "reporting_period": "2025", "std_total": null, "std_approved": null, "std_denied": null, "std_denial_rate": 7.09, "std_denial_rate_printed": 7.09, "std_appeals_total": null, "std_appeals_overturned": null, "std_appeal_overturn_rate": 86.28, "exp_total": null, "exp_approved": null, "exp_denied": null, "exp_denial_rate": 9.64, "ext_review_approved": null, "std_tat_mean_days": 1.33, "std_tat_median_days": 0, "exp_tat_mean_hours": 7.68, "exp_tat_median_hours": 0, "reports_counts": false, "quality_flags": "info:appeals_not_reported; info:percentages_only", "error_count": 0, "warn_count": 0, "source_url": "https://www.aetna.com/content/dam/aetna/pdfs/wwwaetnamedicarecomSSL/individual/website/2025_PA_Metric_Report.pdf", "source_segment": "aetna_ahc", "extraction_note": "Consolidated Aetna MA CMS-0057-F disclosure; percentages and mean/median days only, no raw counts. Expedited TAT converted from days to hours x24. State not printed." }, { "filing_id": "f0101", "parent_org": "CVS Health / Aetna", "plan_name": "Aetna Medicare Advantage - contract H5593", "contract_id": "H5593", "coverage_type": "Medicare Advantage", "state": null, "reporting_period": "CY2025", "std_total": null, "std_approved": null, "std_denied": null, "std_denial_rate": 7, "std_denial_rate_printed": 7, "std_appeals_total": null, "std_appeals_overturned": null, "std_appeal_overturn_rate": 85.71, "exp_total": null, "exp_approved": null, "exp_denied": null, "exp_denial_rate": 16.04, "ext_review_approved": null, "std_tat_mean_days": 1.36, "std_tat_median_days": 0, "exp_tat_mean_hours": 15.84, "exp_tat_median_hours": 0, "reports_counts": false, "quality_flags": "info:appeals_not_reported; info:percentages_only", "error_count": 0, "warn_count": 0, "source_url": "https://www.aetna.com/content/dam/aetna/pdfs/wwwaetnamedicarecomSSL/individual/website/2025_PA_Metric_Report.pdf", "source_segment": "w3_gaps_b", "extraction_note": "Part of the previously-truncated Aetna Medicare consolidated PDF, contract following H5302. 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Expedited TAT converted days->hours (document labels both standard and expedited turnaround in days)." }, { "filing_id": "f0100", "parent_org": "CVS Health / Aetna", "plan_name": "Aetna Medicare Advantage - contract H5522", "contract_id": "H5522", "coverage_type": "Medicare Advantage", "state": null, "reporting_period": "CY2025", "std_total": null, "std_approved": null, "std_denied": null, "std_denial_rate": 6.97, "std_denial_rate_printed": 6.97, "std_appeals_total": null, "std_appeals_overturned": null, "std_appeal_overturn_rate": 90.32, "exp_total": null, "exp_approved": null, "exp_denied": null, "exp_denial_rate": 10.95, "ext_review_approved": null, "std_tat_mean_days": 1.28, "std_tat_median_days": 0, "exp_tat_mean_hours": 6.96, "exp_tat_median_hours": 0, "reports_counts": false, "quality_flags": "info:appeals_not_reported; info:percentages_only", "error_count": 0, "warn_count": 0, "source_url": "https://www.aetna.com/content/dam/aetna/pdfs/wwwaetnamedicarecomSSL/individual/website/2025_PA_Metric_Report.pdf", "source_segment": "w3_gaps_b", "extraction_note": "Part of the previously-truncated Aetna Medicare consolidated PDF, contract following H5302. 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Expedited TAT converted days->hours (document labels both standard and expedited turnaround in days)." }, { "filing_id": "f0080", "parent_org": "CVS Health / Aetna", "plan_name": "Aetna Medicare Advantage - contract H2663", "contract_id": "H2663", "coverage_type": "Medicare Advantage", "state": null, "reporting_period": "2025", "std_total": null, "std_approved": null, "std_denied": null, "std_denial_rate": 6.77, "std_denial_rate_printed": 6.77, "std_appeals_total": null, "std_appeals_overturned": null, "std_appeal_overturn_rate": 90.12, "exp_total": null, "exp_approved": null, "exp_denied": null, "exp_denial_rate": 10.99, "ext_review_approved": null, "std_tat_mean_days": 1.24, "std_tat_median_days": 0, "exp_tat_mean_hours": 6.96, "exp_tat_median_hours": 0, "reports_counts": false, "quality_flags": "info:appeals_not_reported; info:percentages_only", "error_count": 0, "warn_count": 0, "source_url": "https://www.aetna.com/content/dam/aetna/pdfs/wwwaetnamedicarecomSSL/individual/website/2025_PA_Metric_Report.pdf", "source_segment": "aetna_ahc", "extraction_note": "Consolidated Aetna MA CMS-0057-F disclosure; percentages and mean/median days only, no raw counts. Expedited TAT converted from days to hours x24. State not printed." }, { "filing_id": "f0098", "parent_org": "CVS Health / Aetna", "plan_name": "Aetna Medicare Advantage - contract H5337", "contract_id": "H5337", "coverage_type": "Medicare Advantage", "state": null, "reporting_period": "CY2025", "std_total": null, "std_approved": null, "std_denied": null, "std_denial_rate": 6.59, "std_denial_rate_printed": 6.59, "std_appeals_total": null, "std_appeals_overturned": null, "std_appeal_overturn_rate": null, "exp_total": null, "exp_approved": null, "exp_denied": null, "exp_denial_rate": null, "ext_review_approved": null, "std_tat_mean_days": 0.86, "std_tat_median_days": 0, "exp_tat_mean_hours": null, "exp_tat_median_hours": null, "reports_counts": false, "quality_flags": "info:appeals_not_reported; info:percentages_only", "error_count": 0, "warn_count": 0, "source_url": "https://www.aetna.com/content/dam/aetna/pdfs/wwwaetnamedicarecomSSL/individual/website/2025_PA_Metric_Report.pdf", "source_segment": "w3_gaps_b", "extraction_note": "Document prints 'N/A' for appeal-overturn percentage and for the entire expedited-request row for this contract; recorded as null, not zero. 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Expedited TAT converted from days to hours x24. State not printed." }, { "filing_id": "f0104", "parent_org": "CVS Health / Aetna", "plan_name": "Aetna Medicare Advantage - contract H7301", "contract_id": "H7301", "coverage_type": "Medicare Advantage", "state": null, "reporting_period": "CY2025", "std_total": null, "std_approved": null, "std_denied": null, "std_denial_rate": 6.02, "std_denial_rate_printed": 6.02, "std_appeals_total": null, "std_appeals_overturned": null, "std_appeal_overturn_rate": 89.77, "exp_total": null, "exp_approved": null, "exp_denied": null, "exp_denial_rate": 11.51, "ext_review_approved": null, "std_tat_mean_days": 1.21, "std_tat_median_days": 0, "exp_tat_mean_hours": 6.72, "exp_tat_median_hours": 0, "reports_counts": false, "quality_flags": "info:appeals_not_reported; info:percentages_only", "error_count": 0, "warn_count": 0, "source_url": "https://www.aetna.com/content/dam/aetna/pdfs/wwwaetnamedicarecomSSL/individual/website/2025_PA_Metric_Report.pdf", "source_segment": "w3_gaps_b", "extraction_note": "Part of the previously-truncated Aetna Medicare consolidated PDF, contract following H5302. 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Expedited TAT converted days->hours (document labels both standard and expedited turnaround in days)." }, { "filing_id": "f0074", "parent_org": "CVS Health / Aetna", "plan_name": "Aetna Medicare Advantage - contract H1206", "contract_id": "H1206", "coverage_type": "Medicare Advantage", "state": null, "reporting_period": "2025", "std_total": null, "std_approved": null, "std_denied": null, "std_denial_rate": 5.96, "std_denial_rate_printed": 5.96, "std_appeals_total": null, "std_appeals_overturned": null, "std_appeal_overturn_rate": 87.18, "exp_total": null, "exp_approved": null, "exp_denied": null, "exp_denial_rate": 5.95, "ext_review_approved": null, "std_tat_mean_days": 1.17, "std_tat_median_days": 0, "exp_tat_mean_hours": 4.8, "exp_tat_median_hours": 0, "reports_counts": false, "quality_flags": "info:appeals_not_reported; info:percentages_only", "error_count": 0, "warn_count": 0, "source_url": "https://www.aetna.com/content/dam/aetna/pdfs/wwwaetnamedicarecomSSL/individual/website/2025_PA_Metric_Report.pdf", "source_segment": "aetna_ahc", "extraction_note": "Consolidated Aetna MA CMS-0057-F disclosure; percentages and mean/median days only, no raw counts. 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State not printed." }, { "filing_id": "f0056", "parent_org": "CVS Health / Aetna", "plan_name": "Aetna Better Health Premier Plan Michigan", "contract_id": "H8026", "coverage_type": "Medicare-Medicaid Plan", "state": "MI", "reporting_period": "CY2025", "std_total": null, "std_approved": null, "std_denied": null, "std_denial_rate": 5.87, "std_denial_rate_printed": 5.87, "std_appeals_total": null, "std_appeals_overturned": null, "std_appeal_overturn_rate": 33.33, "exp_total": null, "exp_approved": null, "exp_denied": null, "exp_denial_rate": 3.81, "ext_review_approved": null, "std_tat_mean_days": 4.15, "std_tat_median_days": 2, "exp_tat_mean_hours": 38.64, "exp_tat_median_hours": 24, "reports_counts": false, "quality_flags": "info:appeals_not_reported; info:percentages_only", "error_count": 0, "warn_count": 0, "source_url": "https://www.aetnabetterhealth.com/content/dam/aetna/pdfs/PA%20metric%20reporting%20template%20MA%20v3%20Approved_H8026.pdf", "source_segment": "wave2", "extraction_note": "Percentages only, no volumes." }, { "filing_id": "f0102", "parent_org": "CVS Health / Aetna", "plan_name": "Aetna Medicare Advantage - contract H5793", "contract_id": "H5793", "coverage_type": "Medicare Advantage", "state": null, "reporting_period": "CY2025", "std_total": null, "std_approved": null, "std_denied": null, "std_denial_rate": 5.78, "std_denial_rate_printed": 5.78, "std_appeals_total": null, "std_appeals_overturned": null, "std_appeal_overturn_rate": 86.22, "exp_total": null, "exp_approved": null, "exp_denied": null, "exp_denial_rate": 12.88, "ext_review_approved": null, "std_tat_mean_days": 1.13, "std_tat_median_days": 0, "exp_tat_mean_hours": 9.12, "exp_tat_median_hours": 0, "reports_counts": false, "quality_flags": "info:appeals_not_reported; info:percentages_only", "error_count": 0, "warn_count": 0, "source_url": "https://www.aetna.com/content/dam/aetna/pdfs/wwwaetnamedicarecomSSL/individual/website/2025_PA_Metric_Report.pdf", "source_segment": "w3_gaps_b", "extraction_note": "Part of the previously-truncated Aetna Medicare consolidated PDF, contract following H5302. 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Expedited TAT converted days->hours (document labels both standard and expedited turnaround in days)." }, { "filing_id": "f0086", "parent_org": "CVS Health / Aetna", "plan_name": "Aetna Medicare Advantage - contract H3597", "contract_id": "H3597", "coverage_type": "Medicare Advantage", "state": null, "reporting_period": "2025", "std_total": null, "std_approved": null, "std_denied": null, "std_denial_rate": 5.46, "std_denial_rate_printed": 5.46, "std_appeals_total": null, "std_appeals_overturned": null, "std_appeal_overturn_rate": 91.25, "exp_total": null, "exp_approved": null, "exp_denied": null, "exp_denial_rate": 7.77, "ext_review_approved": null, "std_tat_mean_days": 1.15, "std_tat_median_days": 0, "exp_tat_mean_hours": 5.52, "exp_tat_median_hours": 0, "reports_counts": false, "quality_flags": "info:appeals_not_reported; info:percentages_only", "error_count": 0, "warn_count": 0, "source_url": "https://www.aetna.com/content/dam/aetna/pdfs/wwwaetnamedicarecomSSL/individual/website/2025_PA_Metric_Report.pdf", "source_segment": "aetna_ahc", "extraction_note": "Consolidated Aetna MA CMS-0057-F disclosure; percentages and mean/median days only, no raw counts. Expedited TAT converted from days to hours x24. State not printed." } ] }