{ "meta": { "total": 16, "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": "f0268", "parent_org": "Highmark", "plan_name": "Highmark Medicare Advantage contract H7710", "contract_id": "H7710", "coverage_type": "Medicare Advantage", "state": "DE", "reporting_period": "Jan 1, 2025 - Dec 31, 2025", "std_total": 671, "std_approved": 588, "std_denied": 83, "std_denial_rate": 12.37, "std_denial_rate_printed": 12, "std_appeals_total": null, "std_appeals_overturned": null, "std_appeal_overturn_rate": null, "exp_total": 41, "exp_approved": 37, "exp_denied": 4, "exp_denial_rate": 9.76, "ext_review_approved": 5, "std_tat_mean_days": 4.8, "std_tat_median_days": 5, "exp_tat_mean_hours": null, "exp_tat_median_hours": null, "reports_counts": true, "quality_flags": "info:appeals_not_reported", "error_count": 0, "warn_count": 0, "source_url": "https://providers.highmark.com/content/dam/highmark/en/providerresourcecenter/highmark-health-options/hho-de/documents/pdfs/prior-authorization-code-lookup/prior-authorization-metrics.pdf", "source_segment": "blues", "extraction_note": "Consolidated Highmark CMS-0057-F filing hosted on the Highmark Health Options DE provider site; it covers MA, Medicaid and QHP business across PA/DE/WV/NY. Plan marketing name and state are not printed next to most contract IDs. Extended-review values recorded here are the STANDARD-request extension rows. Decision times are printed as '<1 day' for both standard and expedited unless noted, so numeric TAT is left null. DE D-SNP. No appeals data reported for this contract. Expedited extended review: 1 total / 0 approved / 1 denied." }, { "filing_id": "f0267", "parent_org": "Highmark", "plan_name": "Highmark Medicare Advantage contract H5932", "contract_id": "H5932", "coverage_type": "Medicare Advantage", "state": "PA", "reporting_period": "Jan 1, 2025 - Dec 31, 2025", "std_total": 7010, "std_approved": 6152, "std_denied": 857, "std_denial_rate": 12.23, "std_denial_rate_printed": 12, "std_appeals_total": 440, "std_appeals_overturned": 318, "std_appeal_overturn_rate": 72.27, "exp_total": 11889, "exp_approved": 10887, "exp_denied": 1002, "exp_denial_rate": 8.43, "ext_review_approved": 4, "std_tat_mean_days": 4.74, "std_tat_median_days": 5.49, "exp_tat_mean_hours": null, "exp_tat_median_hours": null, "reports_counts": true, "quality_flags": "warn:expedited_exceeds_standard_volume", "error_count": 0, "warn_count": 1, "source_url": "https://providers.highmark.com/content/dam/highmark/en/providerresourcecenter/highmark-health-options/hho-de/documents/pdfs/prior-authorization-code-lookup/prior-authorization-metrics.pdf", "source_segment": "blues", "extraction_note": "Consolidated Highmark CMS-0057-F filing hosted on the Highmark Health Options DE provider site; it covers MA, Medicaid and QHP business across PA/DE/WV/NY. Plan marketing name and state are not printed next to most contract IDs. Extended-review values recorded here are the STANDARD-request extension rows. Decision times are printed as '<1 day' for both standard and expedited unless noted, so numeric TAT is left null. PA D-SNP. Standard approved+denied (6,152+857=7,009) is one less than the stated 7,010 total. The 'within 7 days' sub-row shows 814 denied labelled 95%, internally inconsistent. Expedited appeals: 345 total / 266 approved (77%). Printed median standard TAT (5.49 d) exceeds the printed mean (4.74 d)." }, { "filing_id": "f0273", "parent_org": "Highmark", "plan_name": "Highmark QHP (federal Marketplace) - West Virginia", "contract_id": null, "coverage_type": "Marketplace QHP", "state": "WV", "reporting_period": "Jan 1, 2025 - Dec 31, 2025", "std_total": 25350, "std_approved": 22352, "std_denied": 2998, "std_denial_rate": 11.83, "std_denial_rate_printed": 12, "std_appeals_total": 20, "std_appeals_overturned": 7, "std_appeal_overturn_rate": 35, "exp_total": 6408, "exp_approved": 5806, "exp_denied": 602, "exp_denial_rate": 9.39, "ext_review_approved": null, "std_tat_mean_days": 0.41, "std_tat_median_days": 0, "exp_tat_mean_hours": 13.44, "exp_tat_median_hours": 0, "reports_counts": true, "quality_flags": "warn:expedited_slower_than_standard", "error_count": 0, "warn_count": 1, "source_url": "https://providers.highmark.com/content/dam/highmark/en/providerresourcecenter/highmark-health-options/hho-de/documents/pdfs/prior-authorization-code-lookup/prior-authorization-metrics.pdf", "source_segment": "blues", "extraction_note": "Expedited decision time was published in DAYS and converted to hours (x24); standard TAT left in days as published. No standard extended-review figures printed for the QHP rows. Expedited appeals: 9 total, 2 approved. Standard approval rate (88%) is the lowest of Highmark's four QHP markets." }, { "filing_id": "f0259", "parent_org": "Highmark", "plan_name": "Highmark Medicaid - New York", "contract_id": null, "coverage_type": "Medicaid Managed Care", "state": "NY", "reporting_period": "Jan 1, 2025 - Dec 31, 2025", "std_total": null, "std_approved": null, "std_denied": null, "std_denial_rate": 8.7, "std_denial_rate_printed": 8.7, "std_appeals_total": null, "std_appeals_overturned": null, "std_appeal_overturn_rate": 39.9, "exp_total": null, "exp_approved": null, "exp_denied": null, "exp_denial_rate": 5.4, "ext_review_approved": null, "std_tat_mean_days": 2, "std_tat_median_days": 2, "exp_tat_mean_hours": 24, "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://providers.highmark.com/content/dam/highmark/en/providerresourcecenter/highmark-health-options/hho-de/documents/pdfs/prior-authorization-code-lookup/prior-authorization-metrics.pdf", "source_segment": "blues", "extraction_note": "Section heading in the extracted text reads 'State Medicaid & CHIP FFS programs'; Highmark operates as a managed care organization, so coded Medicaid Managed Care - the heading is ambiguous and may mean these rows mix FFS and MCO business. NY row publishes PERCENTAGES ONLY - no counts. Extended review shown as 2.9% approved. Expedited TAT converted from days to hours (mean 1 d = 24 h; median 1 d = 24 h)." }, { "filing_id": "f0270", "parent_org": "Highmark", "plan_name": "Highmark QHP (federal Marketplace) - Delaware", "contract_id": null, "coverage_type": "Marketplace QHP", "state": "DE", "reporting_period": "Jan 1, 2025 - Dec 31, 2025", "std_total": 16283, "std_approved": 14939, "std_denied": 1344, "std_denial_rate": 8.25, "std_denial_rate_printed": 8, "std_appeals_total": 5, "std_appeals_overturned": 3, "std_appeal_overturn_rate": 60, "exp_total": 3343, "exp_approved": 3056, "exp_denied": 287, "exp_denial_rate": 8.59, "ext_review_approved": null, "std_tat_mean_days": 0.68, "std_tat_median_days": 0, "exp_tat_mean_hours": 12.24, "exp_tat_median_hours": 0, "reports_counts": true, "quality_flags": "clean", "error_count": 0, "warn_count": 0, "source_url": "https://providers.highmark.com/content/dam/highmark/en/providerresourcecenter/highmark-health-options/hho-de/documents/pdfs/prior-authorization-code-lookup/prior-authorization-metrics.pdf", "source_segment": "blues", "extraction_note": "Expedited decision time was published in DAYS and converted to hours (x24); standard TAT left in days as published. No standard extended-review figures printed for the QHP rows. Expedited extended review 1 total / 1 approved. Expedited appeals: 7 total, 3 approved." }, { "filing_id": "f0272", "parent_org": "Highmark", "plan_name": "Highmark QHP (federal Marketplace) - Pennsylvania", "contract_id": null, "coverage_type": "Marketplace QHP", "state": "PA", "reporting_period": "Jan 1, 2025 - Dec 31, 2025", "std_total": 77677, "std_approved": 72961, "std_denied": 4716, "std_denial_rate": 6.07, "std_denial_rate_printed": 6, "std_appeals_total": 50, "std_appeals_overturned": 27, "std_appeal_overturn_rate": 54, "exp_total": 13598, "exp_approved": 12455, "exp_denied": 1143, "exp_denial_rate": 8.41, "ext_review_approved": null, "std_tat_mean_days": 0.43, "std_tat_median_days": 0, "exp_tat_mean_hours": 11.76, "exp_tat_median_hours": 0, "reports_counts": true, "quality_flags": "warn:expedited_slower_than_standard", "error_count": 0, "warn_count": 1, "source_url": "https://providers.highmark.com/content/dam/highmark/en/providerresourcecenter/highmark-health-options/hho-de/documents/pdfs/prior-authorization-code-lookup/prior-authorization-metrics.pdf", "source_segment": "blues", "extraction_note": "Expedited decision time was published in DAYS and converted to hours (x24); standard TAT left in days as published. No standard extended-review figures printed for the QHP rows. Expedited extended review 18 total / 17 approved / 1 denied. Expedited appeals: 16 total, 4 approved. Only 50 standard appeals against 4,716 denials." }, { "filing_id": "f0265", "parent_org": "Highmark", "plan_name": "Highmark Medicare Advantage contract H5106", "contract_id": "H5106", "coverage_type": "Medicare Advantage", "state": null, "reporting_period": "Jan 1, 2025 - Dec 31, 2025", "std_total": 41018, "std_approved": 38901, "std_denied": 2117, "std_denial_rate": 5.16, "std_denial_rate_printed": 5, "std_appeals_total": 199, "std_appeals_overturned": 167, "std_appeal_overturn_rate": 83.92, "exp_total": 23397, "exp_approved": 21986, "exp_denied": 1411, "exp_denial_rate": 6.03, "ext_review_approved": 2189, "std_tat_mean_days": null, "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://providers.highmark.com/content/dam/highmark/en/providerresourcecenter/highmark-health-options/hho-de/documents/pdfs/prior-authorization-code-lookup/prior-authorization-metrics.pdf", "source_segment": "blues", "extraction_note": "Consolidated Highmark CMS-0057-F filing hosted on the Highmark Health Options DE provider site; it covers MA, Medicaid and QHP business across PA/DE/WV/NY. Plan marketing name and state are not printed next to most contract IDs. Extended-review values recorded here are the STANDARD-request extension rows. Decision times are printed as '<1 day' for both standard and expedited unless noted, so numeric TAT is left null. WARNING: the expedited block (23,397 total / 21,986 approved / 1,411 denied) and the expedited extended-review row (1/1/0) appear VERBATIM under H3384, H3957 and H5106, reproduced identically on two independent fetches. Likely a document error or PDF text-extraction artifact - do not treat these three as independent observations. Expedited appeals shown as 133 total / 111 approved - also duplicated." }, { "filing_id": "f0269", "parent_org": "Highmark", "plan_name": "Highmark Medicare Advantage contract H8166", "contract_id": "H8166", "coverage_type": "Medicare Advantage", "state": null, "reporting_period": "Jan 1, 2025 - Dec 31, 2025", "std_total": 27105, "std_approved": 25991, "std_denied": 1114, "std_denial_rate": 4.11, "std_denial_rate_printed": 4, "std_appeals_total": 129, "std_appeals_overturned": 103, "std_appeal_overturn_rate": 79.84, "exp_total": 7979, "exp_approved": 7390, "exp_denied": 589, "exp_denial_rate": 7.38, "ext_review_approved": 2105, "std_tat_mean_days": null, "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://providers.highmark.com/content/dam/highmark/en/providerresourcecenter/highmark-health-options/hho-de/documents/pdfs/prior-authorization-code-lookup/prior-authorization-metrics.pdf", "source_segment": "blues", "extraction_note": "Consolidated Highmark CMS-0057-F filing hosted on the Highmark Health Options DE provider site; it covers MA, Medicaid and QHP business across PA/DE/WV/NY. Plan marketing name and state are not printed next to most contract IDs. Extended-review values recorded here are the STANDARD-request extension rows. Decision times are printed as '<1 day' for both standard and expedited unless noted, so numeric TAT is left null. Expedited appeals: 215 total / 186 approved (87%). Expedited extended review 4 total / 4 approved." }, { "filing_id": "f0263", "parent_org": "Highmark", "plan_name": "Highmark Medicare Advantage contract H3916", "contract_id": "H3916", "coverage_type": "Medicare Advantage", "state": null, "reporting_period": "Jan 1, 2025 - Dec 31, 2025", "std_total": 463352, "std_approved": 445280, "std_denied": 18072, "std_denial_rate": 3.9, "std_denial_rate_printed": 4, "std_appeals_total": 1333, "std_appeals_overturned": 1039, "std_appeal_overturn_rate": 77.94, "exp_total": 81341, "exp_approved": 74476, "exp_denied": 6865, "exp_denial_rate": 8.44, "ext_review_approved": 38884, "std_tat_mean_days": null, "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://providers.highmark.com/content/dam/highmark/en/providerresourcecenter/highmark-health-options/hho-de/documents/pdfs/prior-authorization-code-lookup/prior-authorization-metrics.pdf", "source_segment": "blues", "extraction_note": "Consolidated Highmark CMS-0057-F filing hosted on the Highmark Health Options DE provider site; it covers MA, Medicaid and QHP business across PA/DE/WV/NY. Plan marketing name and state are not printed next to most contract IDs. Extended-review values recorded here are the STANDARD-request extension rows. Decision times are printed as '<1 day' for both standard and expedited unless noted, so numeric TAT is left null. Expedited appeals: 2,865 total / 1,890 approved (66%). Expedited extended review 189 total / 185 approved / 4 denied." }, { "filing_id": "f0261", "parent_org": "Highmark", "plan_name": "Highmark Medicaid - West Virginia", "contract_id": null, "coverage_type": "Medicaid Managed Care", "state": "WV", "reporting_period": "Jan 1, 2025 - Dec 31, 2025", "std_total": 1426, "std_approved": 1371, "std_denied": 55, "std_denial_rate": 3.86, "std_denial_rate_printed": 4, "std_appeals_total": 3, "std_appeals_overturned": 0, "std_appeal_overturn_rate": 0, "exp_total": 1381, "exp_approved": 1343, "exp_denied": 38, "exp_denial_rate": 2.75, "ext_review_approved": 30, "std_tat_mean_days": null, "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://providers.highmark.com/content/dam/highmark/en/providerresourcecenter/highmark-health-options/hho-de/documents/pdfs/prior-authorization-code-lookup/prior-authorization-metrics.pdf", "source_segment": "blues", "extraction_note": "Section heading in the extracted text reads 'State Medicaid & CHIP FFS programs'; Highmark operates as a managed care organization, so coded Medicaid Managed Care - the heading is ambiguous and may mean these rows mix FFS and MCO business. Standard extended-review row reads 31 total / 30 approved / 8 denied, which does not reconcile (30+8 > 31). All decision times printed '<1 day'. Only 3 standard appeals, none overturned." }, { "filing_id": "f0260", "parent_org": "Highmark", "plan_name": "Highmark Medicaid - Pennsylvania", "contract_id": null, "coverage_type": "Medicaid Managed Care", "state": "PA", "reporting_period": "Jan 1, 2025 - Dec 31, 2025", "std_total": 22141, "std_approved": 21291, "std_denied": 850, "std_denial_rate": 3.84, "std_denial_rate_printed": 4, "std_appeals_total": 1744, "std_appeals_overturned": 606, "std_appeal_overturn_rate": 34.75, "exp_total": 15156, "exp_approved": 14730, "exp_denied": 425, "exp_denial_rate": 2.8, "ext_review_approved": 764, "std_tat_mean_days": 1.48, "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://providers.highmark.com/content/dam/highmark/en/providerresourcecenter/highmark-health-options/hho-de/documents/pdfs/prior-authorization-code-lookup/prior-authorization-metrics.pdf", "source_segment": "blues", "extraction_note": "Section heading in the extracted text reads 'State Medicaid & CHIP FFS programs'; Highmark operates as a managed care organization, so coded Medicaid Managed Care - the heading is ambiguous and may mean these rows mix FFS and MCO business. Expedited approved+denied (14,730+425=15,155) is one less than the stated 15,156 total. Standard median and expedited mean/median printed as '<1 day'. Appeal overturn rate 35% is low relative to the MA lines in the same document." }, { "filing_id": "f0271", "parent_org": "Highmark", "plan_name": "Highmark QHP (federal Marketplace) - New York", "contract_id": null, "coverage_type": "Marketplace QHP", "state": "NY", "reporting_period": "Jan 1, 2025 - Dec 31, 2025", "std_total": 1342, "std_approved": 1296, "std_denied": 46, "std_denial_rate": 3.43, "std_denial_rate_printed": null, "std_appeals_total": 0, "std_appeals_overturned": 0, "std_appeal_overturn_rate": null, "exp_total": 165, "exp_approved": 148, "exp_denied": 17, "exp_denial_rate": 10.3, "ext_review_approved": null, "std_tat_mean_days": 0.87, "std_tat_median_days": 0, "exp_tat_mean_hours": 12.48, "exp_tat_median_hours": 0, "reports_counts": true, "quality_flags": "clean", "error_count": 0, "warn_count": 0, "source_url": "https://providers.highmark.com/content/dam/highmark/en/providerresourcecenter/highmark-health-options/hho-de/documents/pdfs/prior-authorization-code-lookup/prior-authorization-metrics.pdf", "source_segment": "blues", "extraction_note": "Expedited decision time was published in DAYS and converted to hours (x24); standard TAT left in days as published. No standard extended-review figures printed for the QHP rows. Zero standard appeals reported. Standard denied percentage not printed." }, { "filing_id": "f0264", "parent_org": "Highmark", "plan_name": "Highmark Medicare Advantage contract H3957", "contract_id": "H3957", "coverage_type": "Medicare Advantage", "state": null, "reporting_period": "Jan 1, 2025 - Dec 31, 2025", "std_total": 98307, "std_approved": 95070, "std_denied": 3237, "std_denial_rate": 3.29, "std_denial_rate_printed": 3, "std_appeals_total": 198, "std_appeals_overturned": 151, "std_appeal_overturn_rate": 76.26, "exp_total": 23397, "exp_approved": 21986, "exp_denied": 1411, "exp_denial_rate": 6.03, "ext_review_approved": 4484, "std_tat_mean_days": null, "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://providers.highmark.com/content/dam/highmark/en/providerresourcecenter/highmark-health-options/hho-de/documents/pdfs/prior-authorization-code-lookup/prior-authorization-metrics.pdf", "source_segment": "blues", "extraction_note": "Consolidated Highmark CMS-0057-F filing hosted on the Highmark Health Options DE provider site; it covers MA, Medicaid and QHP business across PA/DE/WV/NY. Plan marketing name and state are not printed next to most contract IDs. Extended-review values recorded here are the STANDARD-request extension rows. Decision times are printed as '<1 day' for both standard and expedited unless noted, so numeric TAT is left null. WARNING: the expedited block (23,397 total / 21,986 approved / 1,411 denied) and the expedited extended-review row (1/1/0) appear VERBATIM under H3384, H3957 and H5106, reproduced identically on two independent fetches. Likely a document error or PDF text-extraction artifact - do not treat these three as independent observations. Expedited appeals shown as 133 total / 111 approved - also duplicated." }, { "filing_id": "f0258", "parent_org": "Highmark", "plan_name": "Highmark Medicaid - Delaware", "contract_id": null, "coverage_type": "Medicaid Managed Care", "state": "DE", "reporting_period": "Jan 1, 2025 - Dec 31, 2025", "std_total": 32291, "std_approved": 31809, "std_denied": 482, "std_denial_rate": 1.49, "std_denial_rate_printed": 1, "std_appeals_total": 156, "std_appeals_overturned": 38, "std_appeal_overturn_rate": 24.36, "exp_total": 1098, "exp_approved": 1060, "exp_denied": 38, "exp_denial_rate": 3.46, "ext_review_approved": 838, "std_tat_mean_days": 3.8, "std_tat_median_days": 4, "exp_tat_mean_hours": 40.8, "exp_tat_median_hours": 36, "reports_counts": true, "quality_flags": "clean", "error_count": 0, "warn_count": 0, "source_url": "https://providers.highmark.com/content/dam/highmark/en/providerresourcecenter/highmark-health-options/hho-de/documents/pdfs/prior-authorization-code-lookup/prior-authorization-metrics.pdf", "source_segment": "blues", "extraction_note": "Section heading in the extracted text reads 'State Medicaid & CHIP FFS programs'; Highmark operates as a managed care organization, so coded Medicaid Managed Care - the heading is ambiguous and may mean these rows mix FFS and MCO business. Expedited TAT converted from days to hours (mean 1.7 d x 24 = 40.8 h; median 1.5 d x 24 = 36 h)." }, { "filing_id": "f0262", "parent_org": "Highmark", "plan_name": "Highmark Medicare Advantage contract H3384", "contract_id": "H3384", "coverage_type": "Medicare Advantage", "state": null, "reporting_period": "Jan 1, 2025 - Dec 31, 2025", "std_total": 39409, "std_approved": 38823, "std_denied": 586, "std_denial_rate": 1.49, "std_denial_rate_printed": 1, "std_appeals_total": 114, "std_appeals_overturned": 95, "std_appeal_overturn_rate": 83.33, "exp_total": 23397, "exp_approved": 21986, "exp_denied": 1411, "exp_denial_rate": 6.03, "ext_review_approved": 40, "std_tat_mean_days": null, "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://providers.highmark.com/content/dam/highmark/en/providerresourcecenter/highmark-health-options/hho-de/documents/pdfs/prior-authorization-code-lookup/prior-authorization-metrics.pdf", "source_segment": "blues", "extraction_note": "Consolidated Highmark CMS-0057-F filing hosted on the Highmark Health Options DE provider site; it covers MA, Medicaid and QHP business across PA/DE/WV/NY. Plan marketing name and state are not printed next to most contract IDs. Extended-review values recorded here are the STANDARD-request extension rows. Decision times are printed as '<1 day' for both standard and expedited unless noted, so numeric TAT is left null. WARNING: the expedited block (23,397 total / 21,986 approved / 1,411 denied) and the expedited extended-review row (1/1/0) appear VERBATIM under H3384, H3957 and H5106, reproduced identically on two independent fetches. Likely a document error or PDF text-extraction artifact - do not treat these three as independent observations. Also the 'approved within 7 days' sub-row for H3384 standard reads 0 approved out of 38,478, contradicting the 38,823 stated approvals." }, { "filing_id": "f0266", "parent_org": "Highmark", "plan_name": "Highmark Medicare Advantage contract H5526", "contract_id": "H5526", "coverage_type": "Medicare Advantage", "state": null, "reporting_period": "Jan 1, 2025 - Dec 31, 2025", "std_total": 25925, "std_approved": 25551, "std_denied": 374, "std_denial_rate": 1.44, "std_denial_rate_printed": 1, "std_appeals_total": 90, "std_appeals_overturned": 70, "std_appeal_overturn_rate": 77.78, "exp_total": 10481, "exp_approved": 9737, "exp_denied": 744, "exp_denial_rate": 7.1, "ext_review_approved": 54, "std_tat_mean_days": null, "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://providers.highmark.com/content/dam/highmark/en/providerresourcecenter/highmark-health-options/hho-de/documents/pdfs/prior-authorization-code-lookup/prior-authorization-metrics.pdf", "source_segment": "blues", "extraction_note": "Consolidated Highmark CMS-0057-F filing hosted on the Highmark Health Options DE provider site; it covers MA, Medicaid and QHP business across PA/DE/WV/NY. Plan marketing name and state are not printed next to most contract IDs. Extended-review values recorded here are the STANDARD-request extension rows. Decision times are printed as '<1 day' for both standard and expedited unless noted, so numeric TAT is left null. Expedited appeals row (133 total / 111 approved) is identical to the row printed for H3384/H3957/H5106 - possible extraction artifact." } ] }