{
    "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": "f0380",
            "parent_org": "Rocky Mountain Health Plans",
            "plan_name": "Rocky Mountain Health Plans - QHP On-Exchange",
            "contract_id": null,
            "coverage_type": "Marketplace QHP",
            "state": "CO",
            "reporting_period": "CY2025",
            "std_total": 1418,
            "std_approved": 1217,
            "std_denied": 201,
            "std_denial_rate": 14.17,
            "std_denial_rate_printed": 14.17,
            "std_appeals_total": 24,
            "std_appeals_overturned": 18,
            "std_appeal_overturn_rate": 75,
            "exp_total": 4534,
            "exp_approved": 4389,
            "exp_denied": 145,
            "exp_denial_rate": 3.2,
            "ext_review_approved": null,
            "std_tat_mean_days": 3.47,
            "std_tat_median_days": 3,
            "exp_tat_mean_hours": 48.29,
            "exp_tat_median_hours": 18,
            "reports_counts": true,
            "quality_flags": "warn:expedited_exceeds_standard_volume",
            "error_count": 0,
            "warn_count": 1,
            "source_url": "https://www.rmhp.org/wp-content/uploads/2026/03/CMS-Interop-Draft-20260331.pdf",
            "source_segment": "w3_plains",
            "extraction_note": "One PDF covers six RMHP lines of business (QHP On-Exchange, QHP Off-Exchange, CHP+, Medicare Advantage H2582, PRIME, RAE); this is the QHP On-Exchange line. Expedited request volume (4,534) is more than 3x standard volume (1,418) as printed -- unusual but transcribed verbatim. Document is undated internally (no explicit 'CY2025' string found); reporting period inferred from the March 2026 filing/upload date. Appeals figure is a single combined count on the appeals table, not split by standard/expedited -- recorded under std_appeals_* per schema."
        },
        {
            "filing_id": "f0381",
            "parent_org": "Rocky Mountain Health Plans",
            "plan_name": "Rocky Mountain Health Plans Medicare Advantage",
            "contract_id": "H2582",
            "coverage_type": "Medicare Advantage",
            "state": "CO",
            "reporting_period": "CY2025",
            "std_total": 294,
            "std_approved": 257,
            "std_denied": 37,
            "std_denial_rate": 12.59,
            "std_denial_rate_printed": 12.59,
            "std_appeals_total": 1,
            "std_appeals_overturned": 0,
            "std_appeal_overturn_rate": 0,
            "exp_total": 465,
            "exp_approved": 455,
            "exp_denied": 10,
            "exp_denial_rate": 2.15,
            "ext_review_approved": null,
            "std_tat_mean_days": 1.9,
            "std_tat_median_days": 1,
            "exp_tat_mean_hours": 32.55,
            "exp_tat_median_hours": 19,
            "reports_counts": true,
            "quality_flags": "warn:expedited_exceeds_standard_volume",
            "error_count": 0,
            "warn_count": 1,
            "source_url": "https://www.rmhp.org/wp-content/uploads/2026/03/CMS-Interop-Draft-20260331.pdf",
            "source_segment": "w3_plains",
            "extraction_note": "One PDF covers six RMHP lines of business; this is Medicare Advantage contract H2582. Reporting period not explicitly labeled; inferred CY2025 from file date."
        },
        {
            "filing_id": "f0382",
            "parent_org": "Rocky Mountain Health Plans",
            "plan_name": "Rocky Mountain Health Plans PRIME (Medicaid)",
            "contract_id": null,
            "coverage_type": "Medicaid Managed Care",
            "state": "CO",
            "reporting_period": "CY2025",
            "std_total": 1336,
            "std_approved": 1203,
            "std_denied": 133,
            "std_denial_rate": 9.96,
            "std_denial_rate_printed": 9.96,
            "std_appeals_total": 13,
            "std_appeals_overturned": 3,
            "std_appeal_overturn_rate": 23.08,
            "exp_total": 8068,
            "exp_approved": 7581,
            "exp_denied": 487,
            "exp_denial_rate": 6.04,
            "ext_review_approved": null,
            "std_tat_mean_days": 1.57,
            "std_tat_median_days": 1,
            "exp_tat_mean_hours": 18.48,
            "exp_tat_median_hours": 14,
            "reports_counts": true,
            "quality_flags": "warn:expedited_exceeds_standard_volume",
            "error_count": 0,
            "warn_count": 1,
            "source_url": "https://www.rmhp.org/wp-content/uploads/2026/03/CMS-Interop-Draft-20260331.pdf",
            "source_segment": "w3_plains",
            "extraction_note": "One PDF covers six RMHP lines of business; this is 'PRIME', RMHP's Medicaid product (marketed elsewhere as 'RMHP Prime', a UnitedHealthcare Community Plan Colorado Medicaid offering) -- the PDF itself does not define the term. Reporting period not explicitly labeled; inferred CY2025 from file date."
        },
        {
            "filing_id": "f0379",
            "parent_org": "Rocky Mountain Health Plans",
            "plan_name": "Rocky Mountain Health Plans - QHP Off-Exchange (Commercial)",
            "contract_id": null,
            "coverage_type": "Marketplace QHP",
            "state": "CO",
            "reporting_period": "CY2025",
            "std_total": 6912,
            "std_approved": 6280,
            "std_denied": 632,
            "std_denial_rate": 9.14,
            "std_denial_rate_printed": 9.14,
            "std_appeals_total": 110,
            "std_appeals_overturned": 61,
            "std_appeal_overturn_rate": 55.45,
            "exp_total": 5049,
            "exp_approved": 4515,
            "exp_denied": 534,
            "exp_denial_rate": 10.58,
            "ext_review_approved": null,
            "std_tat_mean_days": 4.92,
            "std_tat_median_days": 3,
            "exp_tat_mean_hours": 44.2,
            "exp_tat_median_hours": 15,
            "reports_counts": true,
            "quality_flags": "clean",
            "error_count": 0,
            "warn_count": 0,
            "source_url": "https://www.rmhp.org/wp-content/uploads/2026/03/CMS-Interop-Draft-20260331.pdf",
            "source_segment": "w3_plains",
            "extraction_note": "One PDF covers six RMHP lines of business; this is QHP Off-Exchange (Commercial). Reporting period not explicitly labeled in the document; inferred CY2025 from the file's March 2026 filing date. Appeals figure is a single combined count, not split by standard/expedited."
        },
        {
            "filing_id": "f0383",
            "parent_org": "Rocky Mountain Health Plans",
            "plan_name": "Rocky Mountain Health Plans RAE (Medicaid Regional Accountable Entity)",
            "contract_id": null,
            "coverage_type": "Medicaid Managed Care",
            "state": "CO",
            "reporting_period": "CY2025",
            "std_total": 8244,
            "std_approved": 7518,
            "std_denied": 730,
            "std_denial_rate": 8.85,
            "std_denial_rate_printed": 8.85,
            "std_appeals_total": 72,
            "std_appeals_overturned": 41,
            "std_appeal_overturn_rate": 56.94,
            "exp_total": 8660,
            "exp_approved": 8276,
            "exp_denied": 384,
            "exp_denial_rate": 4.43,
            "ext_review_approved": null,
            "std_tat_mean_days": 1.4,
            "std_tat_median_days": 0,
            "exp_tat_mean_hours": 29.84,
            "exp_tat_median_hours": 16,
            "reports_counts": true,
            "quality_flags": "warn:expedited_exceeds_standard_volume",
            "error_count": 0,
            "warn_count": 1,
            "source_url": "https://www.rmhp.org/wp-content/uploads/2026/03/CMS-Interop-Draft-20260331.pdf",
            "source_segment": "w3_plains",
            "extraction_note": "One PDF covers six RMHP lines of business; this is 'RAE', RMHP's Regional Accountable Entity (Medicaid) line, distinct from PRIME. Printed standard approved+denied (7518+730=8248) does not equal printed standard total (8244) -- a 4-request discrepancy recorded as printed. Reporting period not explicitly labeled; inferred CY2025 from file date."
        },
        {
            "filing_id": "f0378",
            "parent_org": "Rocky Mountain Health Plans",
            "plan_name": "Rocky Mountain Health Plans - CHP+ (Child Health Plan Plus)",
            "contract_id": null,
            "coverage_type": "CHIP Managed Care",
            "state": "CO",
            "reporting_period": "CY2025",
            "std_total": 6163,
            "std_approved": 5691,
            "std_denied": 476,
            "std_denial_rate": 7.72,
            "std_denial_rate_printed": 7.72,
            "std_appeals_total": 27,
            "std_appeals_overturned": 17,
            "std_appeal_overturn_rate": 62.96,
            "exp_total": 1391,
            "exp_approved": 1266,
            "exp_denied": 125,
            "exp_denial_rate": 8.99,
            "ext_review_approved": null,
            "std_tat_mean_days": 1.69,
            "std_tat_median_days": 0,
            "exp_tat_mean_hours": 33.2,
            "exp_tat_median_hours": 11,
            "reports_counts": true,
            "quality_flags": "clean",
            "error_count": 0,
            "warn_count": 0,
            "source_url": "https://www.rmhp.org/wp-content/uploads/2026/03/CMS-Interop-Draft-20260331.pdf",
            "source_segment": "w3_plains",
            "extraction_note": "One PDF covers six RMHP lines of business; this is CHP+ (Child Health Plan Plus). Printed standard approved+denied (5691+476=6167) does not equal the printed standard total (6163) -- a 4-request discrepancy recorded as printed, not corrected. Reporting period not explicitly labeled; inferred CY2025 from file date."
        }
    ]
}