{
    "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": "f0521",
            "parent_org": "Univera Healthcare",
            "plan_name": "Univera Healthcare Medicare D-SNP (HMO)",
            "contract_id": "H7524",
            "coverage_type": "Medicare Advantage",
            "state": "NY",
            "reporting_period": "CY2025",
            "std_total": 118,
            "std_approved": 75,
            "std_denied": 43,
            "std_denial_rate": 36.44,
            "std_denial_rate_printed": 36.4,
            "std_appeals_total": 3,
            "std_appeals_overturned": 1,
            "std_appeal_overturn_rate": 33.33,
            "exp_total": 3,
            "exp_approved": 3,
            "exp_denied": 0,
            "exp_denial_rate": 0,
            "ext_review_approved": null,
            "std_tat_mean_days": 2.5,
            "std_tat_median_days": 2,
            "exp_tat_mean_hours": 36,
            "exp_tat_median_hours": 45.6,
            "reports_counts": true,
            "quality_flags": "clean",
            "error_count": 0,
            "warn_count": 0,
            "source_url": "https://www.excellusbcbs.com/documents/d/global/univerametrics2025",
            "source_segment": "blues",
            "extraction_note": "Expedited decision times were published in DAYS in this report and converted to hours (x24). Extended-review row reports a total and an approved count only, so ext_review_denied is left null (the total is given in this note rather than derived). Document is titled 'Prior Authorization Metrics 2025' and carries a publication date of January 27, 2026. Dual-eligible SNP; coded Medicare Advantage. 63.6% standard approval on a very small base (118 requests). Same shared-contract-ID caveat."
        },
        {
            "filing_id": "f0524",
            "parent_org": "Univera Healthcare",
            "plan_name": "Univera Healthcare MyHealth (MMC)",
            "contract_id": null,
            "coverage_type": "Medicaid Managed Care",
            "state": "NY",
            "reporting_period": "CY2025",
            "std_total": 4910,
            "std_approved": 4127,
            "std_denied": 783,
            "std_denial_rate": 15.95,
            "std_denial_rate_printed": 15.9,
            "std_appeals_total": 26,
            "std_appeals_overturned": 2,
            "std_appeal_overturn_rate": 7.69,
            "exp_total": 54,
            "exp_approved": 47,
            "exp_denied": 7,
            "exp_denial_rate": 12.96,
            "ext_review_approved": 590,
            "std_tat_mean_days": 1.3,
            "std_tat_median_days": 1.2,
            "exp_tat_mean_hours": 9.6,
            "exp_tat_median_hours": 2.4,
            "reports_counts": true,
            "quality_flags": "clean",
            "error_count": 0,
            "warn_count": 0,
            "source_url": "https://www.excellusbcbs.com/documents/d/global/univerametrics2025",
            "source_segment": "blues",
            "extraction_note": "Expedited decision times were published in DAYS in this report and converted to hours (x24). Extended-review row reports a total and an approved count only, so ext_review_denied is left null (the total is given in this note rather than derived). Document is titled 'Prior Authorization Metrics 2025' and carries a publication date of January 27, 2026. Extended review total 678, of which 590 approved."
        },
        {
            "filing_id": "f0525",
            "parent_org": "Univera Healthcare",
            "plan_name": "Univera Healthcare MyHealth Plus (HARP)",
            "contract_id": null,
            "coverage_type": "Medicaid Managed Care",
            "state": "NY",
            "reporting_period": "CY2025",
            "std_total": 498,
            "std_approved": 433,
            "std_denied": 65,
            "std_denial_rate": 13.05,
            "std_denial_rate_printed": 13.1,
            "std_appeals_total": 2,
            "std_appeals_overturned": null,
            "std_appeal_overturn_rate": null,
            "exp_total": 8,
            "exp_approved": 8,
            "exp_denied": 0,
            "exp_denial_rate": 0,
            "ext_review_approved": 74,
            "std_tat_mean_days": 1.1,
            "std_tat_median_days": 0.9,
            "exp_tat_mean_hours": 4.8,
            "exp_tat_median_hours": 2.4,
            "reports_counts": true,
            "quality_flags": "clean",
            "error_count": 0,
            "warn_count": 0,
            "source_url": "https://www.excellusbcbs.com/documents/d/global/univerametrics2025",
            "source_segment": "blues",
            "extraction_note": "Expedited decision times were published in DAYS in this report and converted to hours (x24). Extended-review row reports a total and an approved count only, so ext_review_denied is left null (the total is given in this note rather than derived). Document is titled 'Prior Authorization Metrics 2025' and carries a publication date of January 27, 2026. Extended review total 91, of which 74 approved. 2 appeals reported; outcomes suppressed."
        },
        {
            "filing_id": "f0520",
            "parent_org": "Univera Healthcare",
            "plan_name": "Univera Healthcare Child Health Plus",
            "contract_id": null,
            "coverage_type": "CHIP Managed Care",
            "state": "NY",
            "reporting_period": "CY2025",
            "std_total": 215,
            "std_approved": 201,
            "std_denied": 14,
            "std_denial_rate": 6.51,
            "std_denial_rate_printed": 6.5,
            "std_appeals_total": 1,
            "std_appeals_overturned": null,
            "std_appeal_overturn_rate": null,
            "exp_total": 8,
            "exp_approved": 8,
            "exp_denied": 0,
            "exp_denial_rate": 0,
            "ext_review_approved": 27,
            "std_tat_mean_days": 1.6,
            "std_tat_median_days": 1.4,
            "exp_tat_mean_hours": 26.4,
            "exp_tat_median_hours": 26.4,
            "reports_counts": true,
            "quality_flags": "clean",
            "error_count": 0,
            "warn_count": 0,
            "source_url": "https://www.excellusbcbs.com/documents/d/global/univerametrics2025",
            "source_segment": "blues",
            "extraction_note": "Expedited decision times were published in DAYS in this report and converted to hours (x24). Extended-review row reports a total and an approved count only, so ext_review_denied is left null (the total is given in this note rather than derived). Document is titled 'Prior Authorization Metrics 2025' and carries a publication date of January 27, 2026. Extended review total 33, of which 27 approved. 1 appeal reported; its outcome is suppressed in the document."
        },
        {
            "filing_id": "f0523",
            "parent_org": "Univera Healthcare",
            "plan_name": "Univera Healthcare Medicare PPO",
            "contract_id": "H3335",
            "coverage_type": "Medicare Advantage",
            "state": "NY",
            "reporting_period": "CY2025",
            "std_total": 3301,
            "std_approved": 3095,
            "std_denied": 206,
            "std_denial_rate": 6.24,
            "std_denial_rate_printed": 6.2,
            "std_appeals_total": 43,
            "std_appeals_overturned": 7,
            "std_appeal_overturn_rate": 16.28,
            "exp_total": 101,
            "exp_approved": 89,
            "exp_denied": 12,
            "exp_denial_rate": 11.88,
            "ext_review_approved": null,
            "std_tat_mean_days": 0.9,
            "std_tat_median_days": 0,
            "exp_tat_mean_hours": 12,
            "exp_tat_median_hours": 2.4,
            "reports_counts": true,
            "quality_flags": "clean",
            "error_count": 0,
            "warn_count": 0,
            "source_url": "https://www.excellusbcbs.com/documents/d/global/univerametrics2025",
            "source_segment": "blues",
            "extraction_note": "Expedited decision times were published in DAYS in this report and converted to hours (x24). Extended-review row reports a total and an approved count only, so ext_review_denied is left null (the total is given in this note rather than derived). Document is titled 'Prior Authorization Metrics 2025' and carries a publication date of January 27, 2026. Same shared-contract-ID caveat as the Univera HMO row."
        },
        {
            "filing_id": "f0522",
            "parent_org": "Univera Healthcare",
            "plan_name": "Univera Healthcare Medicare HMO",
            "contract_id": "H3351",
            "coverage_type": "Medicare Advantage",
            "state": "NY",
            "reporting_period": "CY2025",
            "std_total": 32879,
            "std_approved": 31228,
            "std_denied": 1651,
            "std_denial_rate": 5.02,
            "std_denial_rate_printed": 5,
            "std_appeals_total": 315,
            "std_appeals_overturned": 90,
            "std_appeal_overturn_rate": 28.57,
            "exp_total": 847,
            "exp_approved": 733,
            "exp_denied": 114,
            "exp_denial_rate": 13.46,
            "ext_review_approved": null,
            "std_tat_mean_days": 0.9,
            "std_tat_median_days": 0,
            "exp_tat_mean_hours": 16.8,
            "exp_tat_median_hours": 2.4,
            "reports_counts": true,
            "quality_flags": "clean",
            "error_count": 0,
            "warn_count": 0,
            "source_url": "https://www.excellusbcbs.com/documents/d/global/univerametrics2025",
            "source_segment": "blues",
            "extraction_note": "Expedited decision times were published in DAYS in this report and converted to hours (x24). Extended-review row reports a total and an approved count only, so ext_review_denied is left null (the total is given in this note rather than derived). Document is titled 'Prior Authorization Metrics 2025' and carries a publication date of January 27, 2026. Extended review not reported for Medicare lines. NOTE: the same contract IDs (H3351/H3335/H7524) are printed in both the Excellus and Univera reports - Univera is an Excellus/Lifetime Healthcare affiliate and the two filings appear to split shared contracts, so these rows should not be summed with the Excellus rows without checking for double counting."
        }
    ]
}