{
    "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": "f0230",
            "parent_org": "EmblemHealth",
            "plan_name": "EmblemHealth Medicaid and HARP (combined)",
            "contract_id": null,
            "coverage_type": "Medicaid Managed Care",
            "state": "NY",
            "reporting_period": "CY2025",
            "std_total": 115230,
            "std_approved": 89358,
            "std_denied": 25872,
            "std_denial_rate": 22.45,
            "std_denial_rate_printed": null,
            "std_appeals_total": null,
            "std_appeals_overturned": 546,
            "std_appeal_overturn_rate": null,
            "exp_total": 5302,
            "exp_approved": 4574,
            "exp_denied": 728,
            "exp_denial_rate": 13.73,
            "ext_review_approved": 196,
            "std_tat_mean_days": 2.1,
            "std_tat_median_days": null,
            "exp_tat_mean_hours": null,
            "exp_tat_median_hours": null,
            "reports_counts": true,
            "quality_flags": "clean",
            "error_count": 0,
            "warn_count": 0,
            "source_url": "https://www.emblemhealth.com/providers/clinical-corner/um-and-medical-management/pre-authorization-list/preauthorization-metrics",
            "source_segment": "regional",
            "extraction_note": "Printed standard median 57.0 against mean 2.1 - 27x, clearly a different unit or a data error."
        },
        {
            "filing_id": "f0229",
            "parent_org": "EmblemHealth",
            "plan_name": "EmblemHealth Child Health Plus",
            "contract_id": null,
            "coverage_type": "CHIP Managed Care",
            "state": "NY",
            "reporting_period": "CY2025",
            "std_total": 6070,
            "std_approved": 4986,
            "std_denied": 1084,
            "std_denial_rate": 17.86,
            "std_denial_rate_printed": null,
            "std_appeals_total": null,
            "std_appeals_overturned": 53,
            "std_appeal_overturn_rate": null,
            "exp_total": 122,
            "exp_approved": 101,
            "exp_denied": 21,
            "exp_denial_rate": 17.21,
            "ext_review_approved": 3,
            "std_tat_mean_days": 2.1,
            "std_tat_median_days": null,
            "exp_tat_mean_hours": null,
            "exp_tat_median_hours": null,
            "reports_counts": true,
            "quality_flags": "clean",
            "error_count": 0,
            "warn_count": 0,
            "source_url": "https://www.emblemhealth.com/providers/clinical-corner/um-and-medical-management/pre-authorization-list/preauthorization-metrics",
            "source_segment": "regional",
            "extraction_note": "Unit ambiguity; appeals denominator is all requests."
        },
        {
            "filing_id": "f0233",
            "parent_org": "EmblemHealth",
            "plan_name": "EmblemHealth Medicare H5991",
            "contract_id": "H5991",
            "coverage_type": "Medicare Advantage",
            "state": "NY",
            "reporting_period": "CY2025",
            "std_total": 5009,
            "std_approved": 4309,
            "std_denied": 700,
            "std_denial_rate": 13.97,
            "std_denial_rate_printed": null,
            "std_appeals_total": null,
            "std_appeals_overturned": 50,
            "std_appeal_overturn_rate": null,
            "exp_total": 154,
            "exp_approved": 126,
            "exp_denied": 28,
            "exp_denial_rate": 18.18,
            "ext_review_approved": 4,
            "std_tat_mean_days": 1.9,
            "std_tat_median_days": null,
            "exp_tat_mean_hours": null,
            "exp_tat_median_hours": null,
            "reports_counts": true,
            "quality_flags": "clean",
            "error_count": 0,
            "warn_count": 0,
            "source_url": "https://www.emblemhealth.com/providers/clinical-corner/um-and-medical-management/pre-authorization-list/preauthorization-metrics",
            "source_segment": "regional",
            "extraction_note": "Same unit ambiguity; printed median 15.0 against mean 1.9."
        },
        {
            "filing_id": "f0232",
            "parent_org": "EmblemHealth",
            "plan_name": "EmblemHealth Medicare H5228",
            "contract_id": "H5228",
            "coverage_type": "Medicare Advantage",
            "state": "NY",
            "reporting_period": "CY2025",
            "std_total": 29,
            "std_approved": 25,
            "std_denied": 4,
            "std_denial_rate": 13.79,
            "std_denial_rate_printed": null,
            "std_appeals_total": null,
            "std_appeals_overturned": 0,
            "std_appeal_overturn_rate": null,
            "exp_total": 2,
            "exp_approved": 2,
            "exp_denied": 0,
            "exp_denial_rate": 0,
            "ext_review_approved": 0,
            "std_tat_mean_days": 2.1,
            "std_tat_median_days": null,
            "exp_tat_mean_hours": null,
            "exp_tat_median_hours": null,
            "reports_counts": true,
            "quality_flags": "clean",
            "error_count": 0,
            "warn_count": 0,
            "source_url": "https://www.emblemhealth.com/providers/clinical-corner/um-and-medical-management/pre-authorization-list/preauthorization-metrics",
            "source_segment": "regional",
            "extraction_note": "Very small volumes; unit ambiguity."
        },
        {
            "filing_id": "f0231",
            "parent_org": "EmblemHealth",
            "plan_name": "EmblemHealth Medicare H3330",
            "contract_id": "H3330",
            "coverage_type": "Medicare Advantage",
            "state": "NY",
            "reporting_period": "CY2025",
            "std_total": 73246,
            "std_approved": 67575,
            "std_denied": 5671,
            "std_denial_rate": 7.74,
            "std_denial_rate_printed": null,
            "std_appeals_total": null,
            "std_appeals_overturned": 353,
            "std_appeal_overturn_rate": null,
            "exp_total": 2958,
            "exp_approved": 2498,
            "exp_denied": 460,
            "exp_denial_rate": 15.55,
            "ext_review_approved": 51,
            "std_tat_mean_days": 1.3,
            "std_tat_median_days": null,
            "exp_tat_mean_hours": null,
            "exp_tat_median_hours": null,
            "reports_counts": true,
            "quality_flags": "clean",
            "error_count": 0,
            "warn_count": 0,
            "source_url": "https://www.emblemhealth.com/providers/clinical-corner/um-and-medical-management/pre-authorization-list/preauthorization-metrics",
            "source_segment": "regional",
            "extraction_note": "TURNAROUND UNITS AMBIGUOUS: printed standard mean 1.3 vs median 17.0. Median 13x the mean is implausible in one unit; medians left null rather than inferred."
        }
    ]
}