{
    "meta": {
        "total": 18,
        "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": "f0293",
            "parent_org": "Kaiser Permanente",
            "plan_name": "Kaiser Foundation Health Plan of the Northwest - Oregon Medicaid",
            "contract_id": null,
            "coverage_type": "Medicaid Managed Care",
            "state": "OR",
            "reporting_period": "CY2025",
            "std_total": 12578,
            "std_approved": 10009,
            "std_denied": 2569,
            "std_denial_rate": 20.42,
            "std_denial_rate_printed": null,
            "std_appeals_total": 185,
            "std_appeals_overturned": 37,
            "std_appeal_overturn_rate": 20,
            "exp_total": 365,
            "exp_approved": 288,
            "exp_denied": 77,
            "exp_denial_rate": 21.1,
            "ext_review_approved": null,
            "std_tat_mean_days": 6.38,
            "std_tat_median_days": 3.88,
            "exp_tat_mean_hours": 25,
            "exp_tat_median_hours": 5,
            "reports_counts": true,
            "quality_flags": "clean",
            "error_count": 0,
            "warn_count": 0,
            "source_url": "https://healthy.kaiserpermanente.org/content/dam/kporg/legal/prior-authorization-metrics-report-nw-en.pdf",
            "source_segment": "national",
            "extraction_note": "Highest standard denial rate of any Kaiser segment captured."
        },
        {
            "filing_id": "f0300",
            "parent_org": "Kaiser Permanente",
            "plan_name": "Kaiser Permanente Southern California",
            "contract_id": "H0524",
            "coverage_type": "Medicare Advantage",
            "state": "CA",
            "reporting_period": "CY2025",
            "std_total": 143690,
            "std_approved": 115698,
            "std_denied": 27992,
            "std_denial_rate": 19.48,
            "std_denial_rate_printed": null,
            "std_appeals_total": 310,
            "std_appeals_overturned": 79,
            "std_appeal_overturn_rate": 25.48,
            "exp_total": 57195,
            "exp_approved": 55110,
            "exp_denied": 2085,
            "exp_denial_rate": 3.65,
            "ext_review_approved": 2,
            "std_tat_mean_days": 0.92,
            "std_tat_median_days": 0.08,
            "exp_tat_mean_hours": 3,
            "exp_tat_median_hours": 0,
            "reports_counts": true,
            "quality_flags": "clean",
            "error_count": 0,
            "warn_count": 0,
            "source_url": "https://healthy.kaiserpermanente.org/content/dam/kporg/legal/prior-authorization-metrics-report-scal-en.pdf",
            "source_segment": "national",
            "extraction_note": "TAT printed as 'D days H hours', converted."
        },
        {
            "filing_id": "f0292",
            "parent_org": "Kaiser Permanente",
            "plan_name": "Kaiser Foundation Health Plan of the Northwest",
            "contract_id": "H9003",
            "coverage_type": "Medicare Advantage",
            "state": "OR",
            "reporting_period": "CY2025",
            "std_total": 62374,
            "std_approved": 54540,
            "std_denied": 7834,
            "std_denial_rate": 12.56,
            "std_denial_rate_printed": null,
            "std_appeals_total": 154,
            "std_appeals_overturned": 72,
            "std_appeal_overturn_rate": 46.75,
            "exp_total": 2719,
            "exp_approved": 2449,
            "exp_denied": 270,
            "exp_denial_rate": 9.93,
            "ext_review_approved": 0,
            "std_tat_mean_days": 3.71,
            "std_tat_median_days": 0.83,
            "exp_tat_mean_hours": 14,
            "exp_tat_median_hours": 1,
            "reports_counts": true,
            "quality_flags": "clean",
            "error_count": 0,
            "warn_count": 0,
            "source_url": "https://healthy.kaiserpermanente.org/content/dam/kporg/legal/prior-authorization-metrics-report-nw-en.pdf",
            "source_segment": "national",
            "extraction_note": "Region covers OR and SW Washington."
        },
        {
            "filing_id": "f0298",
            "parent_org": "Kaiser Permanente",
            "plan_name": "Kaiser Permanente Northern California (H8794)",
            "contract_id": "H8794",
            "coverage_type": "Medicare Advantage",
            "state": "CA",
            "reporting_period": "CY2025",
            "std_total": 39581,
            "std_approved": 35095,
            "std_denied": 4486,
            "std_denial_rate": 11.33,
            "std_denial_rate_printed": null,
            "std_appeals_total": 129,
            "std_appeals_overturned": 52,
            "std_appeal_overturn_rate": 40.31,
            "exp_total": 15611,
            "exp_approved": 14291,
            "exp_denied": 1320,
            "exp_denial_rate": 8.46,
            "ext_review_approved": 2,
            "std_tat_mean_days": 1.33,
            "std_tat_median_days": 0.88,
            "exp_tat_mean_hours": 24,
            "exp_tat_median_hours": 21,
            "reports_counts": true,
            "quality_flags": "clean",
            "error_count": 0,
            "warn_count": 0,
            "source_url": "https://healthy.kaiserpermanente.org/content/dam/kporg/legal/prior-authorization-metrics-report-ncal-en.pdf",
            "source_segment": "national",
            "extraction_note": null
        },
        {
            "filing_id": "f0301",
            "parent_org": "Kaiser Permanente",
            "plan_name": "Kaiser Permanente Southern California (H8794)",
            "contract_id": "H8794",
            "coverage_type": "Medicare Advantage",
            "state": "CA",
            "reporting_period": "CY2025",
            "std_total": 33855,
            "std_approved": 30149,
            "std_denied": 3706,
            "std_denial_rate": 10.95,
            "std_denial_rate_printed": null,
            "std_appeals_total": 94,
            "std_appeals_overturned": 35,
            "std_appeal_overturn_rate": 37.23,
            "exp_total": 7954,
            "exp_approved": 7731,
            "exp_denied": 223,
            "exp_denial_rate": 2.8,
            "ext_review_approved": 1,
            "std_tat_mean_days": 1,
            "std_tat_median_days": 0.08,
            "exp_tat_mean_hours": 3,
            "exp_tat_median_hours": 0,
            "reports_counts": true,
            "quality_flags": "clean",
            "error_count": 0,
            "warn_count": 0,
            "source_url": "https://healthy.kaiserpermanente.org/content/dam/kporg/legal/prior-authorization-metrics-report-scal-en.pdf",
            "source_segment": "national",
            "extraction_note": null
        },
        {
            "filing_id": "f0297",
            "parent_org": "Kaiser Permanente",
            "plan_name": "Kaiser Permanente Northern California",
            "contract_id": "H0524",
            "coverage_type": "Medicare Advantage",
            "state": "CA",
            "reporting_period": "CY2025",
            "std_total": 144514,
            "std_approved": 129300,
            "std_denied": 15214,
            "std_denial_rate": 10.53,
            "std_denial_rate_printed": null,
            "std_appeals_total": 369,
            "std_appeals_overturned": 136,
            "std_appeal_overturn_rate": 36.86,
            "exp_total": 68652,
            "exp_approved": 63529,
            "exp_denied": 5123,
            "exp_denial_rate": 7.46,
            "ext_review_approved": 0,
            "std_tat_mean_days": 1.58,
            "std_tat_median_days": 0.92,
            "exp_tat_mean_hours": 25,
            "exp_tat_median_hours": 21,
            "reports_counts": true,
            "quality_flags": "clean",
            "error_count": 0,
            "warn_count": 0,
            "source_url": "https://healthy.kaiserpermanente.org/content/dam/kporg/legal/prior-authorization-metrics-report-ncal-en.pdf",
            "source_segment": "national",
            "extraction_note": "Same contract ID H0524 also appears in the SCAL report with different volumes."
        },
        {
            "filing_id": "f0286",
            "parent_org": "Kaiser Permanente",
            "plan_name": "Kaiser Foundation Health Plan of Colorado",
            "contract_id": "H0630",
            "coverage_type": "Medicare Advantage",
            "state": "CO",
            "reporting_period": "CY2025",
            "std_total": 69309,
            "std_approved": 62629,
            "std_denied": 6680,
            "std_denial_rate": 9.64,
            "std_denial_rate_printed": null,
            "std_appeals_total": 143,
            "std_appeals_overturned": 95,
            "std_appeal_overturn_rate": 66.43,
            "exp_total": 50120,
            "exp_approved": 46633,
            "exp_denied": 3487,
            "exp_denial_rate": 6.96,
            "ext_review_approved": null,
            "std_tat_mean_days": 5.33,
            "std_tat_median_days": 1.08,
            "exp_tat_mean_hours": 46,
            "exp_tat_median_hours": 49,
            "reports_counts": true,
            "quality_flags": "clean",
            "error_count": 0,
            "warn_count": 0,
            "source_url": "https://healthy.kaiserpermanente.org/content/dam/kporg/legal/prior-authorization-metrics-report-co-en.pdf",
            "source_segment": "national",
            "extraction_note": "Expedited median (49h) exceeds the expedited mean (46h) as printed."
        },
        {
            "filing_id": "f0288",
            "parent_org": "Kaiser Permanente",
            "plan_name": "Kaiser Foundation Health Plan of Colorado - CHIP",
            "contract_id": null,
            "coverage_type": "CHIP Managed Care",
            "state": "CO",
            "reporting_period": "CY2025",
            "std_total": 1450,
            "std_approved": 1314,
            "std_denied": 136,
            "std_denial_rate": 9.38,
            "std_denial_rate_printed": null,
            "std_appeals_total": 2,
            "std_appeals_overturned": 1,
            "std_appeal_overturn_rate": 50,
            "exp_total": 706,
            "exp_approved": 630,
            "exp_denied": 76,
            "exp_denial_rate": 10.76,
            "ext_review_approved": null,
            "std_tat_mean_days": 2.58,
            "std_tat_median_days": 0.25,
            "exp_tat_mean_hours": 30,
            "exp_tat_median_hours": 24,
            "reports_counts": true,
            "quality_flags": "clean",
            "error_count": 0,
            "warn_count": 0,
            "source_url": "https://healthy.kaiserpermanente.org/content/dam/kporg/legal/prior-authorization-metrics-report-co-en.pdf",
            "source_segment": "national",
            "extraction_note": null
        },
        {
            "filing_id": "f0299",
            "parent_org": "Kaiser Permanente",
            "plan_name": "Kaiser Permanente Northern California - Medi-Cal",
            "contract_id": null,
            "coverage_type": "Medicaid Managed Care",
            "state": "CA",
            "reporting_period": "CY2025",
            "std_total": 24982,
            "std_approved": 22747,
            "std_denied": 2235,
            "std_denial_rate": 8.95,
            "std_denial_rate_printed": null,
            "std_appeals_total": 359,
            "std_appeals_overturned": 111,
            "std_appeal_overturn_rate": 30.92,
            "exp_total": 9581,
            "exp_approved": 8963,
            "exp_denied": 618,
            "exp_denial_rate": 6.45,
            "ext_review_approved": 71,
            "std_tat_mean_days": 1.29,
            "std_tat_median_days": 0.88,
            "exp_tat_mean_hours": 26,
            "exp_tat_median_hours": 21,
            "reports_counts": true,
            "quality_flags": "clean",
            "error_count": 0,
            "warn_count": 0,
            "source_url": "https://healthy.kaiserpermanente.org/content/dam/kporg/legal/prior-authorization-metrics-report-ncal-en.pdf",
            "source_segment": "national",
            "extraction_note": null
        },
        {
            "filing_id": "f0287",
            "parent_org": "Kaiser Permanente",
            "plan_name": "Kaiser Foundation Health Plan of Colorado (H3138)",
            "contract_id": "H3138",
            "coverage_type": "Medicare Advantage",
            "state": "CO",
            "reporting_period": "CY2025",
            "std_total": 876,
            "std_approved": 802,
            "std_denied": 74,
            "std_denial_rate": 8.45,
            "std_denial_rate_printed": null,
            "std_appeals_total": 3,
            "std_appeals_overturned": 3,
            "std_appeal_overturn_rate": 100,
            "exp_total": 530,
            "exp_approved": 492,
            "exp_denied": 38,
            "exp_denial_rate": 7.17,
            "ext_review_approved": null,
            "std_tat_mean_days": 6.96,
            "std_tat_median_days": 3.08,
            "exp_tat_mean_hours": 45,
            "exp_tat_median_hours": 49,
            "reports_counts": true,
            "quality_flags": "clean",
            "error_count": 0,
            "warn_count": 0,
            "source_url": "https://healthy.kaiserpermanente.org/content/dam/kporg/legal/prior-authorization-metrics-report-co-en.pdf",
            "source_segment": "national",
            "extraction_note": "Expedited median exceeds mean as printed."
        },
        {
            "filing_id": "f0294",
            "parent_org": "Kaiser Permanente",
            "plan_name": "Kaiser Mid-Atlantic States - Maryland Medicaid",
            "contract_id": "13202",
            "coverage_type": "Medicaid Managed Care",
            "state": "MD",
            "reporting_period": "CY2025",
            "std_total": null,
            "std_approved": 14541,
            "std_denied": 1028,
            "std_denial_rate": 7.1,
            "std_denial_rate_printed": 7.1,
            "std_appeals_total": 35,
            "std_appeals_overturned": 11,
            "std_appeal_overturn_rate": 31.43,
            "exp_total": null,
            "exp_approved": null,
            "exp_denied": null,
            "exp_denial_rate": null,
            "ext_review_approved": 0,
            "std_tat_mean_days": 1,
            "std_tat_median_days": 0.54,
            "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://healthy.kaiserpermanente.org/content/dam/kporg/legal/prior-authorization-metrics-report-md-medicaid-mas-en.pdf",
            "source_segment": "national",
            "extraction_note": "CONTRADICTION: renders standard approved as '14,541 of 14,541 (90.8%)' while also showing 1,028 denied at 7.1%."
        },
        {
            "filing_id": "f0295",
            "parent_org": "Kaiser Permanente",
            "plan_name": "Kaiser Permanente Hawaii",
            "contract_id": "H1230",
            "coverage_type": "Medicare Advantage",
            "state": "HI",
            "reporting_period": "CY2025",
            "std_total": 22497,
            "std_approved": 20903,
            "std_denied": 1594,
            "std_denial_rate": 7.09,
            "std_denial_rate_printed": null,
            "std_appeals_total": 11,
            "std_appeals_overturned": 7,
            "std_appeal_overturn_rate": 63.64,
            "exp_total": 1661,
            "exp_approved": 1608,
            "exp_denied": 53,
            "exp_denial_rate": 3.19,
            "ext_review_approved": 0,
            "std_tat_mean_days": 1.88,
            "std_tat_median_days": 0.58,
            "exp_tat_mean_hours": 6,
            "exp_tat_median_hours": 1,
            "reports_counts": true,
            "quality_flags": "clean",
            "error_count": 0,
            "warn_count": 0,
            "source_url": "https://healthy.kaiserpermanente.org/content/dam/kporg/legal/prior-authorization-metrics-report-hi-en.pdf",
            "source_segment": "national",
            "extraction_note": null
        },
        {
            "filing_id": "f0302",
            "parent_org": "Kaiser Permanente",
            "plan_name": "Kaiser Permanente Southern California - Medi-Cal",
            "contract_id": null,
            "coverage_type": "Medicaid Managed Care",
            "state": "CA",
            "reporting_period": "CY2025",
            "std_total": 56689,
            "std_approved": 53067,
            "std_denied": 3622,
            "std_denial_rate": 6.39,
            "std_denial_rate_printed": null,
            "std_appeals_total": 234,
            "std_appeals_overturned": 57,
            "std_appeal_overturn_rate": 24.36,
            "exp_total": 7722,
            "exp_approved": 7523,
            "exp_denied": 199,
            "exp_denial_rate": 2.58,
            "ext_review_approved": 0,
            "std_tat_mean_days": 1.88,
            "std_tat_median_days": 0.79,
            "exp_tat_mean_hours": 4,
            "exp_tat_median_hours": 0,
            "reports_counts": true,
            "quality_flags": "clean",
            "error_count": 0,
            "warn_count": 0,
            "source_url": "https://healthy.kaiserpermanente.org/content/dam/kporg/legal/prior-authorization-metrics-report-scal-en.pdf",
            "source_segment": "national",
            "extraction_note": null
        },
        {
            "filing_id": "f0290",
            "parent_org": "Kaiser Permanente",
            "plan_name": "Kaiser Foundation Health Plan of Washington",
            "contract_id": "H5050",
            "coverage_type": "Medicare Advantage",
            "state": "WA",
            "reporting_period": "CY2025",
            "std_total": 184918,
            "std_approved": 173558,
            "std_denied": 11360,
            "std_denial_rate": 6.14,
            "std_denial_rate_printed": null,
            "std_appeals_total": 445,
            "std_appeals_overturned": 313,
            "std_appeal_overturn_rate": 70.34,
            "exp_total": 59203,
            "exp_approved": 54147,
            "exp_denied": 5056,
            "exp_denial_rate": 8.54,
            "ext_review_approved": 0,
            "std_tat_mean_days": 1,
            "std_tat_median_days": 0.17,
            "exp_tat_mean_hours": 17,
            "exp_tat_median_hours": 2,
            "reports_counts": true,
            "quality_flags": "clean",
            "error_count": 0,
            "warn_count": 0,
            "source_url": "https://healthy.kaiserpermanente.org/content/dam/kporg/legal/prior-authorization-metrics-report-wa-en.pdf",
            "source_segment": "national",
            "extraction_note": null
        },
        {
            "filing_id": "f0291",
            "parent_org": "Kaiser Permanente",
            "plan_name": "Kaiser Foundation Health Plan of the Mid-Atlantic States",
            "contract_id": "H2172",
            "coverage_type": "Medicare Advantage",
            "state": "MD",
            "reporting_period": "CY2025",
            "std_total": 90494,
            "std_approved": 85512,
            "std_denied": 4982,
            "std_denial_rate": 5.51,
            "std_denial_rate_printed": null,
            "std_appeals_total": 104,
            "std_appeals_overturned": 72,
            "std_appeal_overturn_rate": 69.23,
            "exp_total": 186,
            "exp_approved": 160,
            "exp_denied": 26,
            "exp_denial_rate": 13.98,
            "ext_review_approved": 0,
            "std_tat_mean_days": 0.13,
            "std_tat_median_days": 0,
            "exp_tat_mean_hours": 4,
            "exp_tat_median_hours": 0,
            "reports_counts": true,
            "quality_flags": "warn:expedited_slower_than_standard",
            "error_count": 0,
            "warn_count": 1,
            "source_url": "https://healthy.kaiserpermanente.org/content/dam/kporg/legal/prior-authorization-metrics-report-mas-en.pdf",
            "source_segment": "national",
            "extraction_note": "Expedited appeal denominator (86) far exceeds the expedited denial count (26), unexplained in source."
        },
        {
            "filing_id": "f0285",
            "parent_org": "Kaiser Permanente",
            "plan_name": "Kaiser Foundation Health Plan (Hawaii QHP)",
            "contract_id": "HIOS 60612",
            "coverage_type": "Marketplace QHP",
            "state": "HI",
            "reporting_period": "CY2025",
            "std_total": 2486,
            "std_approved": 2366,
            "std_denied": 120,
            "std_denial_rate": 4.83,
            "std_denial_rate_printed": null,
            "std_appeals_total": 2,
            "std_appeals_overturned": 2,
            "std_appeal_overturn_rate": 100,
            "exp_total": 121,
            "exp_approved": 119,
            "exp_denied": 2,
            "exp_denial_rate": 1.65,
            "ext_review_approved": 0,
            "std_tat_mean_days": 1.38,
            "std_tat_median_days": 0.17,
            "exp_tat_mean_hours": 6,
            "exp_tat_median_hours": 1,
            "reports_counts": true,
            "quality_flags": "clean",
            "error_count": 0,
            "warn_count": 0,
            "source_url": "https://healthy.kaiserpermanente.org/content/dam/kporg/legal/prior-authorization-metrics-report-hi-en.pdf",
            "source_segment": "national",
            "extraction_note": "Standard appeal line read as two conflicting pairs ('2 of 2, 100%' then '1 of 2, 50%')."
        },
        {
            "filing_id": "f0289",
            "parent_org": "Kaiser Permanente",
            "plan_name": "Kaiser Foundation Health Plan of Georgia",
            "contract_id": "H1170",
            "coverage_type": "Medicare Advantage",
            "state": "GA",
            "reporting_period": "CY2025",
            "std_total": 51523,
            "std_approved": 49908,
            "std_denied": 1615,
            "std_denial_rate": 3.13,
            "std_denial_rate_printed": null,
            "std_appeals_total": 27,
            "std_appeals_overturned": 14,
            "std_appeal_overturn_rate": 51.85,
            "exp_total": 8643,
            "exp_approved": 8372,
            "exp_denied": 271,
            "exp_denial_rate": 3.14,
            "ext_review_approved": 0,
            "std_tat_mean_days": 5.5,
            "std_tat_median_days": 4.79,
            "exp_tat_mean_hours": 35,
            "exp_tat_median_hours": 23,
            "reports_counts": true,
            "quality_flags": "clean",
            "error_count": 0,
            "warn_count": 0,
            "source_url": "https://healthy.kaiserpermanente.org/content/dam/kporg/legal/prior-authorization-metrics-report-ga-en.pdf",
            "source_segment": "national",
            "extraction_note": null
        },
        {
            "filing_id": "f0296",
            "parent_org": "Kaiser Permanente",
            "plan_name": "Kaiser Permanente Hawaii - Medicaid",
            "contract_id": null,
            "coverage_type": "Medicaid Managed Care",
            "state": "HI",
            "reporting_period": "CY2025",
            "std_total": 10185,
            "std_approved": 9924,
            "std_denied": 261,
            "std_denial_rate": 2.56,
            "std_denial_rate_printed": null,
            "std_appeals_total": 1,
            "std_appeals_overturned": 0,
            "std_appeal_overturn_rate": 0,
            "exp_total": 813,
            "exp_approved": 811,
            "exp_denied": 2,
            "exp_denial_rate": 0.25,
            "ext_review_approved": 0,
            "std_tat_mean_days": 1.75,
            "std_tat_median_days": 0.21,
            "exp_tat_mean_hours": 7,
            "exp_tat_median_hours": 1,
            "reports_counts": true,
            "quality_flags": "clean",
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}