{
    "meta": {
        "total": 6,
        "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": "cfhp-starplus",
            "parent_org": "Community First Health Plans",
            "plan_name": "Community First Texas Medicaid STAR+PLUS",
            "contract_id": null,
            "coverage_type": "Medicaid Managed Care",
            "state": "TX",
            "reporting_period": "CY2025",
            "std_total": 8980,
            "std_approved": 7715,
            "std_denied": 646,
            "std_denial_rate": 7.19,
            "std_denial_rate_printed": null,
            "std_appeals_total": 88,
            "std_appeals_overturned": 31,
            "std_appeal_overturn_rate": 35.23,
            "exp_total": 5421,
            "exp_approved": 4242,
            "exp_denied": 233,
            "exp_denial_rate": 4.3,
            "ext_review_approved": null,
            "std_tat_mean_days": 5,
            "std_tat_median_days": 4,
            "exp_tat_mean_hours": 36,
            "exp_tat_median_hours": 24,
            "reports_counts": true,
            "quality_flags": "error:std_counts_reconcile; error:exp_counts_reconcile",
            "error_count": 2,
            "warn_count": 0,
            "source_url": "https://medicaid.communityfirsthealthplans.com/wp-content/uploads/sites/2/2026/03/2025-Prior-Authorization-Metrics-for-Medical-Items-Services-Excluding-Drugs.pdf",
            "source_segment": "filings_2025",
            "extraction_note": null
        },
        {
            "filing_id": "cfhp-starkids",
            "parent_org": "Community First Health Plans",
            "plan_name": "Community First Texas Medicaid STAR Kids",
            "contract_id": null,
            "coverage_type": "Medicaid Managed Care",
            "state": "TX",
            "reporting_period": "CY2025",
            "std_total": 12378,
            "std_approved": 10773,
            "std_denied": 638,
            "std_denial_rate": 5.15,
            "std_denial_rate_printed": null,
            "std_appeals_total": 235,
            "std_appeals_overturned": 86,
            "std_appeal_overturn_rate": 36.6,
            "exp_total": 1773,
            "exp_approved": 1713,
            "exp_denied": 58,
            "exp_denial_rate": 3.27,
            "ext_review_approved": null,
            "std_tat_mean_days": 4,
            "std_tat_median_days": 4,
            "exp_tat_mean_hours": 40.6,
            "exp_tat_median_hours": 24,
            "reports_counts": true,
            "quality_flags": "error:std_counts_reconcile",
            "error_count": 1,
            "warn_count": 0,
            "source_url": "https://medicaid.communityfirsthealthplans.com/wp-content/uploads/sites/2/2026/03/2025-Prior-Authorization-Metrics-for-Medical-Items-Services-Excluding-Drugs.pdf",
            "source_segment": "filings_2025",
            "extraction_note": null
        },
        {
            "filing_id": "cfhp-star",
            "parent_org": "Community First Health Plans",
            "plan_name": "Community First Texas Medicaid STAR",
            "contract_id": null,
            "coverage_type": "Medicaid Managed Care",
            "state": "TX",
            "reporting_period": "CY2025",
            "std_total": 20481,
            "std_approved": 18828,
            "std_denied": 955,
            "std_denial_rate": 4.66,
            "std_denial_rate_printed": null,
            "std_appeals_total": 192,
            "std_appeals_overturned": 89,
            "std_appeal_overturn_rate": 46.35,
            "exp_total": 8994,
            "exp_approved": 7178,
            "exp_denied": 276,
            "exp_denial_rate": 3.07,
            "ext_review_approved": null,
            "std_tat_mean_days": 6,
            "std_tat_median_days": 4,
            "exp_tat_mean_hours": 33.6,
            "exp_tat_median_hours": 48,
            "reports_counts": true,
            "quality_flags": "error:std_counts_reconcile; error:exp_counts_reconcile",
            "error_count": 2,
            "warn_count": 0,
            "source_url": "https://medicaid.communityfirsthealthplans.com/wp-content/uploads/sites/2/2026/03/2025-Prior-Authorization-Metrics-for-Medical-Items-Services-Excluding-Drugs.pdf",
            "source_segment": "filings_2025",
            "extraction_note": null
        },
        {
            "filing_id": "cfhp-chip",
            "parent_org": "Community First Health Plans",
            "plan_name": "Community First CHIP",
            "contract_id": null,
            "coverage_type": "CHIP Managed Care",
            "state": "TX",
            "reporting_period": "CY2025",
            "std_total": 1268,
            "std_approved": 1208,
            "std_denied": 58,
            "std_denial_rate": 4.57,
            "std_denial_rate_printed": null,
            "std_appeals_total": 10,
            "std_appeals_overturned": 3,
            "std_appeal_overturn_rate": 30,
            "exp_total": 242,
            "exp_approved": 174,
            "exp_denied": 24,
            "exp_denial_rate": 9.92,
            "ext_review_approved": null,
            "std_tat_mean_days": 3,
            "std_tat_median_days": 2,
            "exp_tat_mean_hours": 40.6,
            "exp_tat_median_hours": 24,
            "reports_counts": true,
            "quality_flags": "error:exp_counts_reconcile",
            "error_count": 1,
            "warn_count": 0,
            "source_url": "https://medicaid.communityfirsthealthplans.com/wp-content/uploads/sites/2/2026/03/2025-Prior-Authorization-Metrics-for-Medical-Items-Services-Excluding-Drugs.pdf",
            "source_segment": "filings_2025",
            "extraction_note": null
        },
        {
            "filing_id": "cfhp-marketplace",
            "parent_org": "Community First Health Plans",
            "plan_name": "University Community Care Plan (Marketplace)",
            "contract_id": null,
            "coverage_type": "Marketplace QHP",
            "state": "TX",
            "reporting_period": "CY2025",
            "std_total": 2726,
            "std_approved": 2631,
            "std_denied": 76,
            "std_denial_rate": 2.79,
            "std_denial_rate_printed": null,
            "std_appeals_total": 9,
            "std_appeals_overturned": 6,
            "std_appeal_overturn_rate": 66.67,
            "exp_total": 499,
            "exp_approved": 358,
            "exp_denied": 28,
            "exp_denial_rate": 5.61,
            "ext_review_approved": null,
            "std_tat_mean_days": 4,
            "std_tat_median_days": 2,
            "exp_tat_mean_hours": 40.1,
            "exp_tat_median_hours": 24,
            "reports_counts": true,
            "quality_flags": "error:std_counts_reconcile; error:exp_counts_reconcile",
            "error_count": 2,
            "warn_count": 0,
            "source_url": "https://exchange.communityfirsthealthplans.com/wp-content/uploads/sites/4/2026/03/2025-Prior-Authorization-Metrics-for-Medical-Items-Services-Excluding-Drugs.pdf",
            "source_segment": "filings_2025",
            "extraction_note": null
        },
        {
            "filing_id": "cfhp-ma",
            "parent_org": "Community First Health Plans",
            "plan_name": "Community First Medicare Advantage (Alamo & D-SNP)",
            "contract_id": null,
            "coverage_type": "Medicare Advantage",
            "state": "TX",
            "reporting_period": "CY2025",
            "std_total": 508,
            "std_approved": 482,
            "std_denied": 13,
            "std_denial_rate": 2.56,
            "std_denial_rate_printed": null,
            "std_appeals_total": 6,
            "std_appeals_overturned": 1,
            "std_appeal_overturn_rate": 16.67,
            "exp_total": 142,
            "exp_approved": 110,
            "exp_denied": 7,
            "exp_denial_rate": 4.93,
            "ext_review_approved": null,
            "std_tat_mean_days": 4,
            "std_tat_median_days": 3,
            "exp_tat_mean_hours": 54.7,
            "exp_tat_median_hours": 48,
            "reports_counts": true,
            "quality_flags": "error:std_counts_reconcile; error:exp_counts_reconcile",
            "error_count": 2,
            "warn_count": 0,
            "source_url": "https://exchange.communityfirsthealthplans.com/wp-content/uploads/sites/4/2026/03/2025-Prior-Authorization-Metrics-for-Medical-Items-Services-Excluding-Drugs.pdf",
            "source_segment": "filings_2025",
            "extraction_note": "Source prints expedited denied as 67% where 7/142 = 4.9%."
        }
    ]
}