{
    "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": "f0373",
            "parent_org": "Priority Health",
            "plan_name": "Priority Health Choice (Medicaid)",
            "contract_id": null,
            "coverage_type": "Medicaid Managed Care",
            "state": "MI",
            "reporting_period": "CY2025",
            "std_total": 78548,
            "std_approved": 58759,
            "std_denied": 19789,
            "std_denial_rate": 25.19,
            "std_denial_rate_printed": null,
            "std_appeals_total": 1346,
            "std_appeals_overturned": 827,
            "std_appeal_overturn_rate": 61.44,
            "exp_total": 2616,
            "exp_approved": 2279,
            "exp_denied": 337,
            "exp_denial_rate": 12.88,
            "ext_review_approved": 0,
            "std_tat_mean_days": 3.43,
            "std_tat_median_days": 2.17,
            "exp_tat_mean_hours": 47.76,
            "exp_tat_median_hours": 0,
            "reports_counts": true,
            "quality_flags": "clean",
            "error_count": 0,
            "warn_count": 0,
            "source_url": "https://priorityhealth.stylelabs.cloud/api/public/content/Prior_Authorization_Metrics_for_Medical_Items_and_Services-021626_v3.pdf_downloadOriginal",
            "source_segment": "wave2",
            "extraction_note": "Expedited appeal percentages printed as 59%/41% against counts of 32/32, internally inconsistent."
        },
        {
            "filing_id": "f0376",
            "parent_org": "Priority Health",
            "plan_name": "Priority Health Qualified Health Plan",
            "contract_id": null,
            "coverage_type": "Marketplace QHP",
            "state": "MI",
            "reporting_period": "CY2025",
            "std_total": 36916,
            "std_approved": 30432,
            "std_denied": 6484,
            "std_denial_rate": 17.56,
            "std_denial_rate_printed": null,
            "std_appeals_total": 676,
            "std_appeals_overturned": 361,
            "std_appeal_overturn_rate": 53.4,
            "exp_total": 1232,
            "exp_approved": 968,
            "exp_denied": 264,
            "exp_denial_rate": 21.43,
            "ext_review_approved": 0,
            "std_tat_mean_days": 1.17,
            "std_tat_median_days": 1,
            "exp_tat_mean_hours": 11.1,
            "exp_tat_median_hours": 1.57,
            "reports_counts": true,
            "quality_flags": "clean",
            "error_count": 0,
            "warn_count": 0,
            "source_url": "https://priorityhealth.stylelabs.cloud/api/public/content/5421c2c2b1c74ad9ac0cd2fbb2d7cafe",
            "source_segment": "wave2",
            "extraction_note": "Document reports both time-to-determination (recorded) and time-to-written-notification series."
        },
        {
            "filing_id": "priorityhealth-h8379",
            "parent_org": "Priority Health",
            "plan_name": "Priority Health",
            "contract_id": "H8379",
            "coverage_type": "Medicare Advantage",
            "state": "MI",
            "reporting_period": "CY2025",
            "std_total": 12695,
            "std_approved": 11477,
            "std_denied": 1218,
            "std_denial_rate": 9.59,
            "std_denial_rate_printed": null,
            "std_appeals_total": 207,
            "std_appeals_overturned": 142,
            "std_appeal_overturn_rate": 68.6,
            "exp_total": 683,
            "exp_approved": 605,
            "exp_denied": 78,
            "exp_denial_rate": 11.42,
            "ext_review_approved": null,
            "std_tat_mean_days": 2.35,
            "std_tat_median_days": 1,
            "exp_tat_mean_hours": 25.91,
            "exp_tat_median_hours": 24,
            "reports_counts": true,
            "quality_flags": "clean",
            "error_count": 0,
            "warn_count": 0,
            "source_url": "https://priorityhealth.stylelabs.cloud/api/public/content/2025_Prior_Authorization_Metrics_-__Medicare__H8379.pdf_downloadOriginal?v=ccd28dc1",
            "source_segment": "filings_2025",
            "extraction_note": null
        },
        {
            "filing_id": "f0375",
            "parent_org": "Priority Health",
            "plan_name": "Priority Health Medicare PPO",
            "contract_id": "H4875",
            "coverage_type": "Medicare Advantage",
            "state": "MI",
            "reporting_period": "CY2025",
            "std_total": 96478,
            "std_approved": 88570,
            "std_denied": 7908,
            "std_denial_rate": 8.2,
            "std_denial_rate_printed": null,
            "std_appeals_total": 1272,
            "std_appeals_overturned": 932,
            "std_appeal_overturn_rate": 73.27,
            "exp_total": 4640,
            "exp_approved": 4230,
            "exp_denied": 410,
            "exp_denial_rate": 8.84,
            "ext_review_approved": 0,
            "std_tat_mean_days": 2.11,
            "std_tat_median_days": 2,
            "exp_tat_mean_hours": 25.01,
            "exp_tat_median_hours": 9.17,
            "reports_counts": true,
            "quality_flags": "clean",
            "error_count": 0,
            "warn_count": 0,
            "source_url": "https://priorityhealth.stylelabs.cloud/api/public/content/2025_Prior_Authorization_Metrics_-__Medicare_H4875.pdf_downloadOriginal",
            "source_segment": "wave2",
            "extraction_note": "Appeals figure not clearly split standard vs expedited; recorded under standard."
        },
        {
            "filing_id": "f0374",
            "parent_org": "Priority Health",
            "plan_name": "Priority Health Medicare HMO/HMO-POS",
            "contract_id": "H2320",
            "coverage_type": "Medicare Advantage",
            "state": "MI",
            "reporting_period": "CY2025",
            "std_total": 143530,
            "std_approved": 133450,
            "std_denied": 10080,
            "std_denial_rate": 7.02,
            "std_denial_rate_printed": null,
            "std_appeals_total": 1640,
            "std_appeals_overturned": 1199,
            "std_appeal_overturn_rate": 73.11,
            "exp_total": 5520,
            "exp_approved": 5100,
            "exp_denied": 420,
            "exp_denial_rate": 7.61,
            "ext_review_approved": 0,
            "std_tat_mean_days": 2.06,
            "std_tat_median_days": 1,
            "exp_tat_mean_hours": 20.31,
            "exp_tat_median_hours": 24,
            "reports_counts": true,
            "quality_flags": "clean",
            "error_count": 0,
            "warn_count": 0,
            "source_url": "https://priorityhealth.stylelabs.cloud/api/public/content/2025_Prior_Authorization_Metrics_-__Medicare_H2320.pdf_downloadOriginal",
            "source_segment": "wave2",
            "extraction_note": "Expedited median (24h) exceeds mean (20.31h) as printed."
        }
    ]
}