{
    "meta": {
        "total": 3,
        "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": "f0392",
            "parent_org": "Sentara Health",
            "plan_name": "Sentara Health Plans - Medicaid (Cardinal Care)",
            "contract_id": null,
            "coverage_type": "Medicaid Managed Care",
            "state": "VA",
            "reporting_period": "CY2025",
            "std_total": 228807,
            "std_approved": 183059,
            "std_denied": 45748,
            "std_denial_rate": 19.99,
            "std_denial_rate_printed": null,
            "std_appeals_total": 1363,
            "std_appeals_overturned": 443,
            "std_appeal_overturn_rate": 32.5,
            "exp_total": 121645,
            "exp_approved": 105748,
            "exp_denied": 15897,
            "exp_denial_rate": 13.07,
            "ext_review_approved": 0,
            "std_tat_mean_days": 6.4,
            "std_tat_median_days": 5,
            "exp_tat_mean_hours": 26.2,
            "exp_tat_median_hours": 22.4,
            "reports_counts": true,
            "quality_flags": "clean",
            "error_count": 0,
            "warn_count": 0,
            "source_url": "https://www.sentarahealthplans.com/en/company/policies/prior-authorization-metrics",
            "source_segment": "regional",
            "extraction_note": "Expedited volume is 35% of all requests, unusually high."
        },
        {
            "filing_id": "f0391",
            "parent_org": "Sentara Health",
            "plan_name": "Sentara Health Plans - Commercial",
            "contract_id": null,
            "coverage_type": "Marketplace QHP",
            "state": "VA",
            "reporting_period": "CY2025",
            "std_total": 120290,
            "std_approved": 108452,
            "std_denied": 11838,
            "std_denial_rate": 9.84,
            "std_denial_rate_printed": null,
            "std_appeals_total": 127,
            "std_appeals_overturned": 56,
            "std_appeal_overturn_rate": 44.09,
            "exp_total": 16746,
            "exp_approved": 16169,
            "exp_denied": 577,
            "exp_denial_rate": 3.45,
            "ext_review_approved": 0,
            "std_tat_mean_days": 4,
            "std_tat_median_days": 2,
            "exp_tat_mean_hours": 20.1,
            "exp_tat_median_hours": 1,
            "reports_counts": true,
            "quality_flags": "clean",
            "error_count": 0,
            "warn_count": 0,
            "source_url": "https://www.sentarahealthplans.com/en/company/policies/prior-authorization-metrics",
            "source_segment": "regional",
            "extraction_note": "Source labels this 'Commercial'; may include non-exchange group business."
        },
        {
            "filing_id": "f0393",
            "parent_org": "Sentara Health",
            "plan_name": "Sentara Health Plans - Medicare",
            "contract_id": null,
            "coverage_type": "Medicare Advantage",
            "state": "VA",
            "reporting_period": "CY2025",
            "std_total": 49506,
            "std_approved": 46995,
            "std_denied": 2511,
            "std_denial_rate": 5.07,
            "std_denial_rate_printed": null,
            "std_appeals_total": 127,
            "std_appeals_overturned": 134,
            "std_appeal_overturn_rate": 105.51,
            "exp_total": 5527,
            "exp_approved": 5371,
            "exp_denied": 156,
            "exp_denial_rate": 2.82,
            "ext_review_approved": 0,
            "std_tat_mean_days": 4.8,
            "std_tat_median_days": 2,
            "exp_tat_mean_hours": 22,
            "exp_tat_median_hours": 4,
            "reports_counts": true,
            "quality_flags": "error:appeals_exceed_total",
            "error_count": 1,
            "warn_count": 0,
            "source_url": "https://www.sentarahealthplans.com/en/company/policies/prior-authorization-metrics",
            "source_segment": "regional",
            "extraction_note": "CONTRADICTION: 134 overturns against a stated denominator of 127 appeals, printed at 0%. The denominator 127 is identical to the Commercial section's, suggesting a copy error."
        }
    ]
}