{
    "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": "f0366",
            "parent_org": "Point32Health",
            "plan_name": "Harvard Pilgrim Health Care – New Hampshire Exchange Local Choice",
            "contract_id": null,
            "coverage_type": "Marketplace QHP",
            "state": "NH",
            "reporting_period": "CY2025",
            "std_total": 182,
            "std_approved": 150,
            "std_denied": 29,
            "std_denial_rate": 15.93,
            "std_denial_rate_printed": 15.9,
            "std_appeals_total": null,
            "std_appeals_overturned": 0,
            "std_appeal_overturn_rate": null,
            "exp_total": 66,
            "exp_approved": 60,
            "exp_denied": 6,
            "exp_denial_rate": 9.09,
            "ext_review_approved": 0,
            "std_tat_mean_days": 0.72,
            "std_tat_median_days": 0.25,
            "exp_tat_mean_hours": 12.9,
            "exp_tat_median_hours": 3.2,
            "reports_counts": true,
            "quality_flags": "error:std_counts_reconcile",
            "error_count": 1,
            "warn_count": 0,
            "source_url": "https://www.tuftsmedicarepreferred.org/pa-cms-nh-exchange-report",
            "source_segment": "w3_newengland",
            "extraction_note": "Standard-request turnaround is printed on the page in HOURS, not days (verified verbatim: 'Mean (Average) Time: 17.4 hours', 'Median (Middle) Time: 5.9 hours'), unlike every other Point32Health filing in this file which prints standard TAT in days. Converted hours->days here (17.4/24=0.725, 5.9/24=0.246) to fit the std_tat_*_days field; raw printed hour values were 17.4 mean / 5.9 median. Also: printed std_approved (150) + std_denied (29) = 179, not the printed std_total of 182 — recorded exactly as printed; the 3-unit gap is unexplained by the document."
        },
        {
            "filing_id": "f0368",
            "parent_org": "Point32Health",
            "plan_name": "Tufts Health RITogether",
            "contract_id": null,
            "coverage_type": "Medicaid Managed Care",
            "state": "RI",
            "reporting_period": "CY2025",
            "std_total": 352,
            "std_approved": 297,
            "std_denied": 55,
            "std_denial_rate": 15.62,
            "std_denial_rate_printed": 15.7,
            "std_appeals_total": null,
            "std_appeals_overturned": 1,
            "std_appeal_overturn_rate": null,
            "exp_total": 90,
            "exp_approved": 80,
            "exp_denied": 10,
            "exp_denial_rate": 11.11,
            "ext_review_approved": 0,
            "std_tat_mean_days": 5.7,
            "std_tat_median_days": 3.8,
            "exp_tat_mean_hours": 17.3,
            "exp_tat_median_hours": 16.5,
            "reports_counts": true,
            "quality_flags": "clean",
            "error_count": 0,
            "warn_count": 0,
            "source_url": "https://www.tuftsmedicarepreferred.org/pa-cms-ri-together-report",
            "source_segment": "w3_newengland",
            "extraction_note": "Same CMS-template format as Tufts Health One Care report (count | denominator | printed %). Appeals-filed total not separately published; 'approved after appeal: 1' printed with a percentage of total requests, not of appeals — appeal_overturn_pct omitted for the same reason as One Care."
        },
        {
            "filing_id": "f0369",
            "parent_org": "Point32Health",
            "plan_name": "Tufts Health Together Managed Care Organization (MCO)",
            "contract_id": null,
            "coverage_type": "Medicaid Managed Care",
            "state": "MA",
            "reporting_period": "CY2025",
            "std_total": 2058,
            "std_approved": 1906,
            "std_denied": 152,
            "std_denial_rate": 7.39,
            "std_denial_rate_printed": 7.4,
            "std_appeals_total": null,
            "std_appeals_overturned": 1,
            "std_appeal_overturn_rate": null,
            "exp_total": 229,
            "exp_approved": 195,
            "exp_denied": 34,
            "exp_denial_rate": 14.85,
            "ext_review_approved": null,
            "std_tat_mean_days": 4.9,
            "std_tat_median_days": 3.9,
            "exp_tat_mean_hours": 13.6,
            "exp_tat_median_hours": 4.8,
            "reports_counts": true,
            "quality_flags": "clean",
            "error_count": 0,
            "warn_count": 0,
            "source_url": "https://www.tuftsmedicarepreferred.org/pa-cms-ma-together-report",
            "source_segment": "w3_newengland",
            "extraction_note": "Third of three sub-plan tables on the shared Tufts Health Together report page (see Cambridge Health Alliance row note). Appeals-filed total not separately published."
        },
        {
            "filing_id": "f0371",
            "parent_org": "Point32Health",
            "plan_name": "Tufts Health Together with UMass Memorial Health",
            "contract_id": null,
            "coverage_type": "Medicaid Managed Care",
            "state": "MA",
            "reporting_period": "CY2025",
            "std_total": 6367,
            "std_approved": 6036,
            "std_denied": 331,
            "std_denial_rate": 5.2,
            "std_denial_rate_printed": 5.2,
            "std_appeals_total": null,
            "std_appeals_overturned": 10,
            "std_appeal_overturn_rate": null,
            "exp_total": 512,
            "exp_approved": 441,
            "exp_denied": 71,
            "exp_denial_rate": 13.87,
            "ext_review_approved": null,
            "std_tat_mean_days": 4.6,
            "std_tat_median_days": 4.9,
            "exp_tat_mean_hours": 31.5,
            "exp_tat_median_hours": 18.5,
            "reports_counts": true,
            "quality_flags": "clean",
            "error_count": 0,
            "warn_count": 0,
            "source_url": "https://www.tuftsmedicarepreferred.org/pa-cms-ma-together-report",
            "source_segment": "w3_newengland",
            "extraction_note": "One of three sub-plan tables on the shared Tufts Health Together report page (see Cambridge Health Alliance row note). Appeals-filed total not separately published."
        },
        {
            "filing_id": "f0367",
            "parent_org": "Point32Health",
            "plan_name": "Tufts Health One Care",
            "contract_id": null,
            "coverage_type": "Medicare-Medicaid Plan",
            "state": "MA",
            "reporting_period": "CY2025",
            "std_total": 9942,
            "std_approved": 9497,
            "std_denied": 445,
            "std_denial_rate": 4.48,
            "std_denial_rate_printed": 4.5,
            "std_appeals_total": null,
            "std_appeals_overturned": 31,
            "std_appeal_overturn_rate": null,
            "exp_total": 686,
            "exp_approved": 612,
            "exp_denied": 74,
            "exp_denial_rate": 10.79,
            "ext_review_approved": 0,
            "std_tat_mean_days": 4,
            "std_tat_median_days": 2.7,
            "exp_tat_mean_hours": 7.6,
            "exp_tat_median_hours": 1.3,
            "reports_counts": true,
            "quality_flags": "clean",
            "error_count": 0,
            "warn_count": 0,
            "source_url": "https://www.tuftsmedicarepreferred.org/pa-cms-one-care-report",
            "source_segment": "w3_newengland",
            "extraction_note": "Verified % signs are literally printed on page next to counts (e.g. 'Request approved 9,497 9,942 95.5%'), not calculated. Document also prints 'approved after appeal: 31 (0.3%)' where the 0.3% denominator is total standard requests (9,942), not appeals filed — appeals_total (number of appeals filed) is not separately published, so std_appeals_total and std_appeal_overturn_pct are omitted to avoid implying an appeals-filed denominator. 'Approved after extension' = 0 for both standard and expedited per document; recorded once under ext_review_approved (standard bucket)."
        },
        {
            "filing_id": "f0370",
            "parent_org": "Point32Health",
            "plan_name": "Tufts Health Together with Cambridge Health Alliance (CHA)",
            "contract_id": null,
            "coverage_type": "Medicaid Managed Care",
            "state": "MA",
            "reporting_period": "CY2025",
            "std_total": 3526,
            "std_approved": 3386,
            "std_denied": 140,
            "std_denial_rate": 3.97,
            "std_denial_rate_printed": 4,
            "std_appeals_total": null,
            "std_appeals_overturned": 2,
            "std_appeal_overturn_rate": null,
            "exp_total": 152,
            "exp_approved": 132,
            "exp_denied": 20,
            "exp_denial_rate": 13.16,
            "ext_review_approved": null,
            "std_tat_mean_days": 5.2,
            "std_tat_median_days": 3.9,
            "exp_tat_mean_hours": 49.5,
            "exp_tat_median_hours": 5.6,
            "reports_counts": true,
            "quality_flags": "clean",
            "error_count": 0,
            "warn_count": 0,
            "source_url": "https://www.tuftsmedicarepreferred.org/pa-cms-ma-together-report",
            "source_segment": "w3_newengland",
            "extraction_note": "This single URL publishes three separate Tufts Health Together sub-plan tables (Cambridge Health Alliance, UMass Memorial Health, and the general MCO line); recorded here as three separate filing rows sharing this source_url, distinguished by plan_name. Appeals-filed total not separately published (same caveat as One Care/RITogether)."
        }
    ]
}