{
    "meta": {
        "total": 4,
        "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": "f0021",
            "parent_org": "AmeriHealth Caritas Family of Companies",
            "plan_name": "AmeriHealth Caritas District of Columbia",
            "contract_id": null,
            "coverage_type": "Medicaid Managed Care",
            "state": "DC",
            "reporting_period": "CY2025",
            "std_total": 99165,
            "std_approved": 80119,
            "std_denied": 18953,
            "std_denial_rate": 19.11,
            "std_denial_rate_printed": 19.11,
            "std_appeals_total": null,
            "std_appeals_overturned": 148,
            "std_appeal_overturn_rate": null,
            "exp_total": 1175,
            "exp_approved": 1085,
            "exp_denied": 87,
            "exp_denial_rate": 7.4,
            "ext_review_approved": null,
            "std_tat_mean_days": 0.72,
            "std_tat_median_days": 1,
            "exp_tat_mean_hours": 8.37,
            "exp_tat_median_hours": 3,
            "reports_counts": true,
            "quality_flags": "clean",
            "error_count": 0,
            "warn_count": 0,
            "source_url": "https://www.amerihealthcaritasdc.com/member/medicaid/information/prior-authorization-reporting",
            "source_segment": "aetna_ahc",
            "extraction_note": "std_appeals_overturned is the printed 'approved after appeal' count; total appeals filed not printed. Expedited approved after appeal: 5. Approved other than requested: 93 standard, 3 expedited. Extended review published as a percentage only (0.3% standard, 0.1% expedited). Printed approval rates: 80.79% standard, 92.34% expedited.",
            "source_sha256": null,
            "service_list_url": null,
            "service_list_items": null,
            "entity_id": "mcd:DC:amerihealth-caritas-district-of-columbia",
            "filing_unit": "medicaid_plan"
        },
        {
            "filing_id": "f0221",
            "parent_org": "Elevance Health",
            "plan_name": "Wellpoint District of Columbia",
            "contract_id": null,
            "coverage_type": "Medicaid Managed Care",
            "state": "DC",
            "reporting_period": "CY2025",
            "std_total": null,
            "std_approved": null,
            "std_denied": null,
            "std_denial_rate": 8.9,
            "std_denial_rate_printed": 8.9,
            "std_appeals_total": null,
            "std_appeals_overturned": null,
            "std_appeal_overturn_rate": 61.9,
            "exp_total": null,
            "exp_approved": null,
            "exp_denied": null,
            "exp_denial_rate": 19.7,
            "ext_review_approved": null,
            "std_tat_mean_days": 3,
            "std_tat_median_days": 3,
            "exp_tat_mean_hours": 24,
            "exp_tat_median_hours": 24,
            "reports_counts": false,
            "quality_flags": "info:appeals_not_reported; info:percentages_only",
            "error_count": 0,
            "warn_count": 0,
            "source_url": "https://www.wellpoint.com/content/dam/digital/wellpoint/documents/medicaid/district-of-columbia/dc_medicaid_chip_priorauthsmetrics.pdf",
            "source_segment": "wave2",
            "extraction_note": "Percentages only. Expedited denial rate (19.7%) more than double the standard rate.",
            "source_sha256": null,
            "service_list_url": null,
            "service_list_items": null,
            "entity_id": "mcd:DC:amerigroup-district-of-columbia",
            "filing_unit": "medicaid_plan"
        },
        {
            "filing_id": "f0497",
            "parent_org": "UnitedHealth Group",
            "plan_name": "District of Columbia Dual Choice Program",
            "contract_id": null,
            "coverage_type": "Medicare-Medicaid Plan",
            "state": "DC",
            "reporting_period": "CY2025",
            "std_total": 23,
            "std_approved": 21,
            "std_denied": 2,
            "std_denial_rate": 8.7,
            "std_denial_rate_printed": null,
            "std_appeals_total": null,
            "std_appeals_overturned": 0,
            "std_appeal_overturn_rate": null,
            "exp_total": 1,
            "exp_approved": 1,
            "exp_denied": 0,
            "exp_denial_rate": 0,
            "ext_review_approved": null,
            "std_tat_mean_days": 0,
            "std_tat_median_days": 0.9,
            "exp_tat_mean_hours": 0,
            "exp_tat_median_hours": 0,
            "reports_counts": true,
            "quality_flags": "clean",
            "error_count": 0,
            "warn_count": 0,
            "source_url": "https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicaid-2025.pdf",
            "source_segment": "wave2",
            "extraction_note": null,
            "source_sha256": null,
            "service_list_url": null,
            "service_list_items": null,
            "entity_id": "mcd:DC:unitedhealthcare-community-plan-of-district-of-columbia",
            "filing_unit": "medicaid_plan"
        },
        {
            "filing_id": "f0496",
            "parent_org": "UnitedHealth Group",
            "plan_name": "District of Columbia Dual Choice - Medicaid LTSS",
            "contract_id": null,
            "coverage_type": "Medicare-Medicaid Plan",
            "state": "DC",
            "reporting_period": "CY2025",
            "std_total": 11877,
            "std_approved": 11089,
            "std_denied": 788,
            "std_denial_rate": 6.63,
            "std_denial_rate_printed": null,
            "std_appeals_total": null,
            "std_appeals_overturned": 3,
            "std_appeal_overturn_rate": null,
            "exp_total": 2,
            "exp_approved": 2,
            "exp_denied": 0,
            "exp_denial_rate": 0,
            "ext_review_approved": null,
            "std_tat_mean_days": 1,
            "std_tat_median_days": 1.5,
            "exp_tat_mean_hours": 0,
            "exp_tat_median_hours": 0,
            "reports_counts": true,
            "quality_flags": "clean",
            "error_count": 0,
            "warn_count": 0,
            "source_url": "https://www.uhc.com/content/dam/uhcdotcom/en/Legal/PDF/CMS-Interoperability-Medicaid-2025.pdf",
            "source_segment": "wave2",
            "extraction_note": null,
            "source_sha256": null,
            "service_list_url": null,
            "service_list_items": null,
            "entity_id": "mcd:DC:unitedhealthcare-community-plan-of-district-of-columbia",
            "filing_unit": "medicaid_plan"
        }
    ]
}