{ "meta": { "total": 9, "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": "f0135", "parent_org": "Centene", "plan_name": "Ambetter from Louisiana Healthcare Connections", "contract_id": null, "coverage_type": "Marketplace QHP", "state": "LA", "reporting_period": "CY2025", "std_total": 22862, "std_approved": 17318, "std_denied": 5544, "std_denial_rate": 24.25, "std_denial_rate_printed": 24.25, "std_appeals_total": 523, "std_appeals_overturned": 160, "std_appeal_overturn_rate": 30.59, "exp_total": 1230, "exp_approved": 919, "exp_denied": 311, "exp_denial_rate": 25.28, "ext_review_approved": null, "std_tat_mean_days": 3, "std_tat_median_days": 2, "exp_tat_mean_hours": 24, "exp_tat_median_hours": 0, "reports_counts": true, "quality_flags": "clean", "error_count": 0, "warn_count": 0, "source_url": "https://www.ambetterhealth.com/content/dam/centene/louisiana-health-connect/ambetter/pdf/LA_MKT_ABLAHealthcareConnect_90787_MetricsSummary_R.pdf", "source_segment": "w3_qhp", "extraction_note": "Issuer ID 90787. Expedited appeals: 33 total, 17 overturned (51.52%) - not in fixed fields. Expedited TAT printed in days (mean 1, median 0); converted to hours (24h/0h) per schema - native unit was days.", "source_sha256": null, "service_list_url": null, "service_list_items": null, "entity_id": "qhp:LA:90787", "filing_unit": "qhp_issuer" }, { "filing_id": "f0160", "parent_org": "Centene", "plan_name": "Louisiana Healthcare Connections", "contract_id": null, "coverage_type": "Medicaid Managed Care", "state": "LA", "reporting_period": "CY2025", "std_total": 154350, "std_approved": 119472, "std_denied": 34878, "std_denial_rate": 22.6, "std_denial_rate_printed": null, "std_appeals_total": 967, "std_appeals_overturned": 250, "std_appeal_overturn_rate": 25.85, "exp_total": 2224, "exp_approved": 1829, "exp_denied": 395, "exp_denial_rate": 17.76, "ext_review_approved": 5526, "std_tat_mean_days": 2, "std_tat_median_days": 1, "exp_tat_mean_hours": 24, "exp_tat_median_hours": 24, "reports_counts": true, "quality_flags": "clean", "error_count": 0, "warn_count": 0, "source_url": "https://www.louisianahealthconnect.com/content/dam/centene/medicaid/pdfs/provider/prior-authorization-requirements-metrics/LA_LAHCC_Medicaid_37_MetricsSummary_R.pdf", "source_segment": "wave2", "extraction_note": "Document prints TWO different standard appeal-overturn percentages: 25.98% (250 of 967) and 59.98% 'of those with outcomes'.", "source_sha256": null, "service_list_url": null, "service_list_items": null, "entity_id": "mcd:LA:louisiana-healthcare-connections", "filing_unit": "medicaid_plan" }, { "filing_id": "f0065", "parent_org": "CVS Health / Aetna", "plan_name": "Aetna Better Health of Louisiana", "contract_id": null, "coverage_type": "Medicaid Managed Care", "state": "LA", "reporting_period": "CY2025", "std_total": 79506, "std_approved": 67439, "std_denied": 12067, "std_denial_rate": 15.18, "std_denial_rate_printed": 15.18, "std_appeals_total": 556, "std_appeals_overturned": 164, "std_appeal_overturn_rate": 29.5, "exp_total": 2062, "exp_approved": 1596, "exp_denied": 466, "exp_denial_rate": 22.6, "ext_review_approved": 58, "std_tat_mean_days": 2.29, "std_tat_median_days": 2, "exp_tat_mean_hours": 22.32, "exp_tat_median_hours": 24, "reports_counts": true, "quality_flags": "clean", "error_count": 0, "warn_count": 0, "source_url": "https://www.aetnabetterhealth.com/content/dam/aetna/medicaid/louisiana/providers/pdf/2025_ABHLA_CMS_Web_Metrics-Provider.pdf", "source_segment": "aetna_ahc", "extraction_note": "Expedited TAT printed in days (0.93 mean / 1.0 median); converted to hours x24. ext_review_approved = standard extended review 58 of 102; expedited 28 of 42. Doc also states 81,568 total PAs processed and 99.66% on-time.", "source_sha256": null, "service_list_url": null, "service_list_items": null, "entity_id": "mcd:LA:aetna-better-health-of-louisiana", "filing_unit": "medicaid_plan" }, { "filing_id": "f0501", "parent_org": "UnitedHealth Group", "plan_name": "Healthy Louisiana", "contract_id": null, "coverage_type": "Medicaid Managed Care", "state": "LA", "reporting_period": "CY2025", "std_total": 136355, "std_approved": 117615, "std_denied": 18740, "std_denial_rate": 13.74, "std_denial_rate_printed": null, "std_appeals_total": null, "std_appeals_overturned": 74, "std_appeal_overturn_rate": null, "exp_total": 19807, "exp_approved": 17303, "exp_denied": 2504, "exp_denial_rate": 12.64, "ext_review_approved": null, "std_tat_mean_days": 0, "std_tat_median_days": 0.7, "exp_tat_mean_hours": 0, "exp_tat_median_hours": 4.8, "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:LA:unitedhealthcare-community-plan", "filing_unit": "medicaid_plan" }, { "filing_id": "f0013", "parent_org": "AmeriHealth Caritas", "plan_name": "AmeriHealth Caritas Louisiana", "contract_id": null, "coverage_type": "Medicaid Managed Care", "state": "LA", "reporting_period": "CY2025", "std_total": 87451, "std_approved": 76939, "std_denied": 9398, "std_denial_rate": 10.75, "std_denial_rate_printed": null, "std_appeals_total": null, "std_appeals_overturned": null, "std_appeal_overturn_rate": null, "exp_total": 1821, "exp_approved": 1697, "exp_denied": 114, "exp_denial_rate": 6.26, "ext_review_approved": null, "std_tat_mean_days": 1.78, "std_tat_median_days": 1, "exp_tat_mean_hours": 14.14, "exp_tat_median_hours": 17, "reports_counts": true, "quality_flags": "error:std_counts_reconcile; error:exp_counts_reconcile; info:appeals_not_reported", "error_count": 2, "warn_count": 0, "source_url": "https://www.amerihealthcaritasla.com/member/info/prior-authorization-reporting", "source_segment": "states", "extraction_note": "'Approved other than requested' published as a percentage only. Expedited mean (14.14h) is LOWER than the expedited median (17h) as published.", "source_sha256": null, "service_list_url": null, "service_list_items": null, "entity_id": "mcd:LA:amerihealth-caritas-louisiana", "filing_unit": "medicaid_plan" }, { "filing_id": "christus-pc2659", "parent_org": "CHRISTUS Health", "plan_name": "CHRISTUS Health Plan (LA Marketplace)", "contract_id": "PC2659", "coverage_type": "Marketplace QHP", "state": "LA", "reporting_period": "CY2025", "std_total": 351, "std_approved": 325, "std_denied": 26, "std_denial_rate": 7.41, "std_denial_rate_printed": null, "std_appeals_total": null, "std_appeals_overturned": 0, "std_appeal_overturn_rate": null, "exp_total": 62, "exp_approved": 59, "exp_denied": 3, "exp_denial_rate": 4.84, "ext_review_approved": 0, "std_tat_mean_days": 2.3, "std_tat_median_days": 2, "exp_tat_mean_hours": 36, "exp_tat_median_hours": 24, "reports_counts": true, "quality_flags": "clean", "error_count": 0, "warn_count": 0, "source_url": "https://chppayment.christushealth.org/documents/2026/General/LA%20HIX%20Determination%20statistics_PC2659.pdf", "source_segment": "filings_2025", "extraction_note": null, "source_sha256": null, "service_list_url": null, "service_list_items": null, "entity_id": "qhp:LA:98780", "filing_unit": "qhp_issuer" }, { "filing_id": "f0038", "parent_org": "Blue Cross and Blue Shield of Louisiana", "plan_name": "HMO Louisiana, Inc.", "contract_id": null, "coverage_type": "Marketplace QHP", "state": "LA", "reporting_period": "CY2025", "std_total": 62789, "std_approved": 58722, "std_denied": 4067, "std_denial_rate": 6.48, "std_denial_rate_printed": 6.48, "std_appeals_total": 394, "std_appeals_overturned": 143, "std_appeal_overturn_rate": 36.29, "exp_total": 4209, "exp_approved": 4055, "exp_denied": 154, "exp_denial_rate": 3.66, "ext_review_approved": null, "std_tat_mean_days": null, "std_tat_median_days": 0, "exp_tat_mean_hours": 17, "exp_tat_median_hours": 4, "reports_counts": true, "quality_flags": "clean", "error_count": 0, "warn_count": 0, "source_url": "https://www.lablue.com/landing/cmsauth", "source_segment": "w3_blues", "extraction_note": "Same source document/page as the LHSIC filing above (both plans reported on one page). Standard TAT average printed as '< 1 day' -- left null. Median 0 days per the document's auto-approval footnote. 36% appeal-approval rate is as printed (143/394 is ~36.3%).", "source_sha256": null, "service_list_url": null, "service_list_items": null, "entity_id": "qhp:LA:19636", "filing_unit": "qhp_issuer" }, { "filing_id": "f0039", "parent_org": "Blue Cross and Blue Shield of Louisiana", "plan_name": "Louisiana Health Services Insurance Company (LHSIC)", "contract_id": null, "coverage_type": "Marketplace QHP", "state": "LA", "reporting_period": "CY2025", "std_total": 10856, "std_approved": 10158, "std_denied": 698, "std_denial_rate": 6.43, "std_denial_rate_printed": 6.43, "std_appeals_total": 87, "std_appeals_overturned": 25, "std_appeal_overturn_rate": 28.74, "exp_total": 1002, "exp_approved": 962, "exp_denied": 40, "exp_denial_rate": 3.99, "ext_review_approved": null, "std_tat_mean_days": null, "std_tat_median_days": 0, "exp_tat_mean_hours": 18, "exp_tat_median_hours": 5, "reports_counts": true, "quality_flags": "clean", "error_count": 0, "warn_count": 0, "source_url": "https://www.lablue.com/landing/cmsauth", "source_segment": "w3_blues", "extraction_note": "Page titled 'CMS Prior Authorization Reporting - Qualified Health Plans | Louisiana Blue', reporting period printed as '01/01/2025-12/31/2025'. Standard TAT average printed as '< 1 day' (not an exact figure) -- left null rather than guessing a number; document's own footnote says the median is 0 days 'because of the Louisiana Blue auto-approval rate for prior authorization requests'. Approval/denial percentages and the 29% appeal-approval rate are as printed by the payer, not computed here (25/87 appeals approved works out to ~28.7%, printed as 29%).", "source_sha256": null, "service_list_url": null, "service_list_items": null, "entity_id": "qhp:LA:19636", "filing_unit": "qhp_issuer" }, { "filing_id": "f0316", "parent_org": "Humana", "plan_name": "Humana Healthy Horizons in Louisiana", "contract_id": null, "coverage_type": "Medicaid Managed Care", "state": "LA", "reporting_period": "2025", "std_total": 36389, "std_approved": 34621, "std_denied": 1768, "std_denial_rate": 4.86, "std_denial_rate_printed": 4.86, "std_appeals_total": 55, "std_appeals_overturned": 17, "std_appeal_overturn_rate": 30.91, "exp_total": 797, "exp_approved": 554, "exp_denied": 243, "exp_denial_rate": 30.49, "ext_review_approved": 0, "std_tat_mean_days": 2, "std_tat_median_days": 1, "exp_tat_mean_hours": 7, "exp_tat_median_hours": 3, "reports_counts": true, "quality_flags": "clean", "error_count": 0, "warn_count": 0, "source_url": "https://assets.humana.com/is/content/humana/Humana_LA_Prior_Auth_Metrics_PlanYear2025pdf", "source_segment": "w5_humana", "extraction_note": "parsed from the published template by pipeline.preauth.extract (humana)", "source_sha256": "02b9eb933ca9170cef799e0464cd8f08f1bb9c8aa4c633f703c4e2fe7bf00e8a", "service_list_url": "https://provider.humana.com/MedicaidPAL", "service_list_items": null, "entity_id": "mcd:LA:humana-healthy-horizons", "filing_unit": "medicaid_plan" } ] }