{ "meta": { "total": 14, "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": "f0486", "parent_org": "UCare", "plan_name": "Prepaid Medical Assistance Program (PMAP)", "contract_id": null, "coverage_type": "Medicaid Managed Care", "state": "MN", "reporting_period": "CY2025", "std_total": 30736, "std_approved": 16043, "std_denied": 14693, "std_denial_rate": 47.8, "std_denial_rate_printed": null, "std_appeals_total": 850, "std_appeals_overturned": 113, "std_appeal_overturn_rate": 13.29, "exp_total": 469, "exp_approved": 356, "exp_denied": 113, "exp_denial_rate": 24.09, "ext_review_approved": 0, "std_tat_mean_days": 6, "std_tat_median_days": 8, "exp_tat_mean_hours": 24, "exp_tat_median_hours": 24, "reports_counts": true, "quality_flags": "warn:high_denial_rate", "error_count": 0, "warn_count": 1, "source_url": "https://ucm-p-001.sitecorecontenthub.cloud/api/public/content/U15479_PAMetricsReport__PMAP_2026.pdf", "source_segment": "sweep", "extraction_note": "Mean standard TAT (6 days) is below the median (8 days).", "source_sha256": null, "service_list_url": null, "service_list_items": null, "entity_id": "mcd:MN:ucare", "filing_unit": "medicaid_plan" }, { "filing_id": "f0488", "parent_org": "UCare", "plan_name": "UCare Connect + Medicare", "contract_id": "H5937", "coverage_type": "Medicare Advantage", "state": "MN", "reporting_period": "CY2025", "std_total": 3685, "std_approved": 1969, "std_denied": 1716, "std_denial_rate": 46.57, "std_denial_rate_printed": null, "std_appeals_total": 107, "std_appeals_overturned": 32, "std_appeal_overturn_rate": 29.91, "exp_total": 241, "exp_approved": 201, "exp_denied": 40, "exp_denial_rate": 16.6, "ext_review_approved": 0, "std_tat_mean_days": 6, "std_tat_median_days": 7, "exp_tat_mean_hours": 24, "exp_tat_median_hours": 24, "reports_counts": true, "quality_flags": "warn:high_denial_rate", "error_count": 0, "warn_count": 1, "source_url": "https://ucm-p-001.sitecorecontenthub.cloud/api/public/content/U15479_PAMetricsReport__ConnectPlus_H5937_2026.pdf", "source_segment": "sweep", "extraction_note": "Integrated Medicare-Medicaid special needs product under an MA contract.", "source_sha256": null, "service_list_url": null, "service_list_items": null, "entity_id": "mcd:MN:ucare", "filing_unit": "medicaid_plan" }, { "filing_id": "f0487", "parent_org": "UCare", "plan_name": "UCare Connect", "contract_id": null, "coverage_type": "Medicaid Managed Care", "state": "MN", "reporting_period": "CY2025", "std_total": 6578, "std_approved": 3606, "std_denied": 2972, "std_denial_rate": 45.18, "std_denial_rate_printed": null, "std_appeals_total": 142, "std_appeals_overturned": 47, "std_appeal_overturn_rate": 33.1, "exp_total": 200, "exp_approved": 135, "exp_denied": 65, "exp_denial_rate": 32.5, "ext_review_approved": 0, "std_tat_mean_days": 7, "std_tat_median_days": 8, "exp_tat_mean_hours": 48, "exp_tat_median_hours": 24, "reports_counts": true, "quality_flags": "warn:high_denial_rate", "error_count": 0, "warn_count": 1, "source_url": "https://ucm-p-001.sitecorecontenthub.cloud/api/public/content/U15479_PAMetricsReport__Connect_2026.pdf", "source_segment": "sweep", "extraction_note": "Special Needs BasicCare (Medicaid-only) product.", "source_sha256": null, "service_list_url": null, "service_list_items": null, "entity_id": "mcd:MN:ucare", "filing_unit": "medicaid_plan" }, { "filing_id": "f0485", "parent_org": "UCare", "plan_name": "MinnesotaCare (MnCare)", "contract_id": null, "coverage_type": "Medicaid Managed Care", "state": "MN", "reporting_period": "CY2025", "std_total": 6208, "std_approved": 3406, "std_denied": 2802, "std_denial_rate": 45.14, "std_denial_rate_printed": null, "std_appeals_total": 66, "std_appeals_overturned": 8, "std_appeal_overturn_rate": 12.12, "exp_total": 70, "exp_approved": 54, "exp_denied": 16, "exp_denial_rate": 22.86, "ext_review_approved": 0, "std_tat_mean_days": 8, "std_tat_median_days": 8, "exp_tat_mean_hours": 24, "exp_tat_median_hours": 24, "reports_counts": true, "quality_flags": "warn:high_denial_rate", "error_count": 0, "warn_count": 1, "source_url": "https://ucm-p-001.sitecorecontenthub.cloud/api/public/content/U15479_PAMetricsReport__MnCare_2026.pdf", "source_segment": "sweep", "extraction_note": "MinnesotaCare is a Basic Health Program; no exact enum exists, recorded as Medicaid Managed Care.", "source_sha256": null, "service_list_url": null, "service_list_items": null, "entity_id": "mcd:MN:ucare", "filing_unit": "medicaid_plan" }, { "filing_id": "f0490", "parent_org": "UCare", "plan_name": "UCare Minnesota Senior Health Options (MSHO)", "contract_id": "H2456", "coverage_type": "Medicare Advantage", "state": "MN", "reporting_period": "CY2025", "std_total": 4469, "std_approved": 2506, "std_denied": 1963, "std_denial_rate": 43.92, "std_denial_rate_printed": null, "std_appeals_total": 102, "std_appeals_overturned": 26, "std_appeal_overturn_rate": 25.49, "exp_total": 612, "exp_approved": 563, "exp_denied": 49, "exp_denial_rate": 8.01, "ext_review_approved": 0, "std_tat_mean_days": 6, "std_tat_median_days": 7, "exp_tat_mean_hours": 24, "exp_tat_median_hours": 24, "reports_counts": true, "quality_flags": "warn:high_denial_rate", "error_count": 0, "warn_count": 1, "source_url": "https://ucm-p-001.sitecorecontenthub.cloud/api/public/content/U15479_PAMetricsReport__MSHO_H2456_2026.pdf", "source_segment": "sweep", "extraction_note": "Integrated Medicare-Medicaid product operating under an MA contract.", "source_sha256": null, "service_list_url": null, "service_list_items": null, "entity_id": "mcd:MN:ucare", "filing_unit": "medicaid_plan" }, { "filing_id": "f0484", "parent_org": "UCare", "plan_name": "Minnesota Senior Care Plus (MSC+)", "contract_id": null, "coverage_type": "Medicaid Managed Care", "state": "MN", "reporting_period": "CY2025", "std_total": 1101, "std_approved": 640, "std_denied": 461, "std_denial_rate": 41.87, "std_denial_rate_printed": null, "std_appeals_total": 15, "std_appeals_overturned": 4, "std_appeal_overturn_rate": 26.67, "exp_total": 28, "exp_approved": 17, "exp_denied": 11, "exp_denial_rate": 39.29, "ext_review_approved": 0, "std_tat_mean_days": 8, "std_tat_median_days": 8, "exp_tat_mean_hours": 24, "exp_tat_median_hours": 24, "reports_counts": true, "quality_flags": "warn:high_denial_rate", "error_count": 0, "warn_count": 1, "source_url": "https://ucm-p-001.sitecorecontenthub.cloud/api/public/content/U15479_PAMetricsReport__MSCPlus_2026.pdf", "source_segment": "sweep", "extraction_note": "Expedited TAT published in days, x24.", "source_sha256": null, "service_list_url": null, "service_list_items": null, "entity_id": "mcd:MN:ucare", "filing_unit": "medicaid_plan" }, { "filing_id": "f0483", "parent_org": "UCare", "plan_name": "EssentiaCare Plans", "contract_id": "H8783", "coverage_type": "Medicare Advantage", "state": "MN", "reporting_period": "CY2025", "std_total": 382, "std_approved": 248, "std_denied": 134, "std_denial_rate": 35.08, "std_denial_rate_printed": null, "std_appeals_total": 8, "std_appeals_overturned": 6, "std_appeal_overturn_rate": 75, "exp_total": 38, "exp_approved": 36, "exp_denied": 2, "exp_denial_rate": 5.26, "ext_review_approved": 0, "std_tat_mean_days": 1, "std_tat_median_days": 0, "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://ucm-p-001.sitecorecontenthub.cloud/api/public/content/U15479_PAMetricsReport_EssentiaCare_H8783_2026.pdf", "source_segment": "sweep", "extraction_note": "State not printed; MN assigned from the publisher.", "source_sha256": null, "service_list_url": null, "service_list_items": null, "entity_id": null, "filing_unit": null }, { "filing_id": "f0489", "parent_org": "UCare", "plan_name": "UCare Medicare Plans", "contract_id": "H2459", "coverage_type": "Medicare Advantage", "state": "MN", "reporting_period": "CY2025", "std_total": 18305, "std_approved": 13013, "std_denied": 5292, "std_denial_rate": 28.91, "std_denial_rate_printed": null, "std_appeals_total": 208, "std_appeals_overturned": 109, "std_appeal_overturn_rate": 52.4, "exp_total": 2011, "exp_approved": 1911, "exp_denied": 100, "exp_denial_rate": 4.97, "ext_review_approved": 0, "std_tat_mean_days": 2, "std_tat_median_days": 0, "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://ucm-p-001.sitecorecontenthub.cloud/api/public/content/74U15479_PAMetricsReport__Medicare_H2459_2026.pdf", "source_segment": "sweep", "extraction_note": "State not printed; MN assigned from publisher.", "source_sha256": null, "service_list_url": null, "service_list_items": null, "entity_id": "mcd:MN:ucare", "filing_unit": "medicaid_plan" }, { "filing_id": "f0460", "parent_org": "Sanford Health", "plan_name": "Sanford Health Plan QHP - Minnesota", "contract_id": "MN-52346", "coverage_type": "Marketplace QHP", "state": "MN", "reporting_period": "CY2025", "std_total": 33, "std_approved": 25, "std_denied": 8, "std_denial_rate": 24.24, "std_denial_rate_printed": null, "std_appeals_total": 0, "std_appeals_overturned": 0, "std_appeal_overturn_rate": null, "exp_total": 2, "exp_approved": 2, "exp_denied": 0, "exp_denial_rate": 0, "ext_review_approved": 0, "std_tat_mean_days": 1, "std_tat_median_days": 1, "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.sanfordhealthplan.com/-/media/files/documents/final_hp-b134-minnesota-52346-cms-interoperability.pdf", "source_segment": "regional", "extraction_note": "Very small denominators.", "source_sha256": null, "service_list_url": null, "service_list_items": null, "entity_id": null, "filing_unit": null }, { "filing_id": "f0491", "parent_org": "UCare", "plan_name": "UCare Your Choice Plans", "contract_id": "H8070", "coverage_type": "Medicare Advantage", "state": "MN", "reporting_period": "CY2025", "std_total": 3837, "std_approved": 2959, "std_denied": 878, "std_denial_rate": 22.88, "std_denial_rate_printed": null, "std_appeals_total": 166, "std_appeals_overturned": 95, "std_appeal_overturn_rate": 57.23, "exp_total": 816, "exp_approved": 750, "exp_denied": 66, "exp_denial_rate": 8.09, "ext_review_approved": 0, "std_tat_mean_days": 5, "std_tat_median_days": 2, "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://ucm-p-001.sitecorecontenthub.cloud/api/public/content/U15479_PAMetricsReport__YourChoice_H8070_2026.pdf", "source_segment": "sweep", "extraction_note": "State not printed; MN assigned from publisher.", "source_sha256": null, "service_list_url": null, "service_list_items": null, "entity_id": "mcd:MN:ucare", "filing_unit": "medicaid_plan" }, { "filing_id": "f0257", "parent_org": "HealthPartners", "plan_name": "HealthPartners Minnesota Health Care Programs (Medicaid)", "contract_id": null, "coverage_type": "Medicaid Managed Care", "state": "MN", "reporting_period": "CY2025 (January 1, 2025 - December 31, 2025)", "std_total": 11816, "std_approved": 10807, "std_denied": 1009, "std_denial_rate": 8.54, "std_denial_rate_printed": 9, "std_appeals_total": 247, "std_appeals_overturned": 96, "std_appeal_overturn_rate": 38.87, "exp_total": 1992, "exp_approved": 1884, "exp_denied": 108, "exp_denial_rate": 5.42, "ext_review_approved": null, "std_tat_mean_days": 3, "std_tat_median_days": 0, "exp_tat_mean_hours": 10.58, "exp_tat_median_hours": 2.1, "reports_counts": true, "quality_flags": "clean", "error_count": 0, "warn_count": 0, "source_url": "https://www.healthpartners.com/content/dam/corporate/integrity-compliance/pa-reporting-cy2025-ma-medadv-msho-indwionexch.pdf", "source_segment": "w3_midwest", "extraction_note": "Expedited appeals were also reported separately (14 total, 8 overturned) but this schema has no exp_appeals fields, so only standard-appeal figures (247/96) are typed; expedited appeal counts noted here only. This PDF is the second of two HealthPartners CY2025 PA disclosures found on their site; a separate page (https://www.healthpartners.com/legal/prior-authorization-reporting/) covers Minnesota commercial/SEGIP/PEIP business only, which is out of this territory's scope (not Medicaid/CHIP/Medicaid FFS) and was not extracted here.", "source_sha256": null, "service_list_url": null, "service_list_items": null, "entity_id": null, "filing_unit": null }, { "filing_id": "f0256", "parent_org": "HealthPartners", "plan_name": "HealthPartners Medicare Advantage and Minnesota Senior Health Options (MSHO), combined", "contract_id": null, "coverage_type": "Multiple (combined)", "state": "MN", "reporting_period": "CY2025 (January 1, 2025 - December 31, 2025)", "std_total": 11994, "std_approved": 11241, "std_denied": 753, "std_denial_rate": 6.28, "std_denial_rate_printed": 6, "std_appeals_total": 203, "std_appeals_overturned": 175, "std_appeal_overturn_rate": 86.21, "exp_total": 1151, "exp_approved": 1082, "exp_denied": 69, "exp_denial_rate": 5.99, "ext_review_approved": null, "std_tat_mean_days": 2, "std_tat_median_days": 0, "exp_tat_mean_hours": 7.72, "exp_tat_median_hours": 0.09, "reports_counts": true, "quality_flags": "clean", "error_count": 0, "warn_count": 0, "source_url": "https://www.healthpartners.com/content/dam/corporate/integrity-compliance/pa-reporting-cy2025-ma-medadv-msho-indwionexch.pdf", "source_segment": "w3_midwest", "extraction_note": "Document combines standard Medicare Advantage with Minnesota Senior Health Options (MSHO, a Medicare-Medicaid dual-eligible integrated plan) into one reporting line and cannot be split from what was extracted -- coverage_type set to 'Multiple (combined)' per brief guidance since MSHO would otherwise be 'Medicare-Medicaid Plan' and general MA is 'Medicare Advantage'. Expedited appeals reported separately (22 total, 15 overturned) but no exp_appeals field exists in this schema; noted here only.", "source_sha256": null, "service_list_url": null, "service_list_items": null, "entity_id": "ma:H2422", "filing_unit": "ma_contract" }, { "filing_id": "f0040", "parent_org": "Blue Cross and Blue Shield of Minnesota", "plan_name": "Blue Cross and Blue Shield of Minnesota (Blue Cross plans)", "contract_id": null, "coverage_type": "Marketplace QHP", "state": "MN", "reporting_period": "Jan 1, 2025 - Dec 31, 2025", "std_total": null, "std_approved": null, "std_denied": null, "std_denial_rate": null, "std_denial_rate_printed": null, "std_appeals_total": null, "std_appeals_overturned": null, "std_appeal_overturn_rate": null, "exp_total": null, "exp_approved": null, "exp_denied": null, "exp_denial_rate": null, "ext_review_approved": null, "std_tat_mean_days": null, "std_tat_median_days": null, "exp_tat_mean_hours": null, "exp_tat_median_hours": null, "reports_counts": true, "quality_flags": "info:appeals_not_reported", "error_count": 0, "warn_count": 0, "source_url": "https://www.bluecrossmn.com/providers/medical-management/prior-authorization-and-appeals-data", "source_segment": "blues", "extraction_note": "FORMAT DIFFERS FROM THE CMS TEMPLATE: Blue Cross MN publishes counts broken out by service category (inpatient/outpatient behavioral health, inpatient/outpatient medical, prescription drug) rather than the standard/expedited split, and it includes prescription drugs which CMS-0057-F excludes. No expedited section, no extended-review section and no decision-time metrics are published. Aggregate template fields are left null rather than summed across categories. Coverage type is inferred only from the plan branding (Blue Plus is the MN Medicaid/state public programs entity) and is not labelled in the source. Blue Cross standard counts by category: inpatient behavioral health 2,183 total/2,075 approved/108 denied; inpatient medical 1,064/1,056/8; outpatient behavioral health 3,398/3,067/331; outpatient medical 76,481/69,313/7,168; prescription drug 105,266/59,175/46,091. Appeals by category: 5/106/1/520/573 total with 3/67/0/339/283 overturned. The linked '2025 Interoperability Report' PDF (bluecrossmn.widen.net) could not be fetched - blocked by robots.txt.", "source_sha256": null, "service_list_url": null, "service_list_items": null, "entity_id": null, "filing_unit": null }, { "filing_id": "f0041", "parent_org": "Blue Cross and Blue Shield of Minnesota", "plan_name": "Blue Plus (Blue Cross and Blue Shield of Minnesota)", "contract_id": null, "coverage_type": "Medicaid Managed Care", "state": "MN", "reporting_period": "Jan 1, 2025 - Dec 31, 2025", "std_total": null, "std_approved": null, "std_denied": null, "std_denial_rate": null, "std_denial_rate_printed": null, "std_appeals_total": null, "std_appeals_overturned": null, "std_appeal_overturn_rate": null, "exp_total": null, "exp_approved": null, "exp_denied": null, "exp_denial_rate": null, "ext_review_approved": null, "std_tat_mean_days": null, "std_tat_median_days": null, "exp_tat_mean_hours": null, "exp_tat_median_hours": null, "reports_counts": true, "quality_flags": "info:appeals_not_reported", "error_count": 0, "warn_count": 0, "source_url": "https://www.bluecrossmn.com/providers/medical-management/prior-authorization-and-appeals-data", "source_segment": "blues", "extraction_note": "FORMAT DIFFERS FROM THE CMS TEMPLATE: Blue Cross MN publishes counts broken out by service category (inpatient/outpatient behavioral health, inpatient/outpatient medical, prescription drug) rather than the standard/expedited split, and it includes prescription drugs which CMS-0057-F excludes. No expedited section, no extended-review section and no decision-time metrics are published. Aggregate template fields are left null rather than summed across categories. Coverage type is inferred only from the plan branding (Blue Plus is the MN Medicaid/state public programs entity) and is not labelled in the source. Blue Plus standard counts by category: inpatient behavioral health 7,495 total/7,390 approved/105 denied; inpatient medical 2,355/2,161/194; outpatient behavioral health 3,690/3,622/68; outpatient medical 113,706/107,446/6,260; prescription drug 5,432/2,807/2,625. Appeals by category: 2/81/10/1,640/10,094 total with 1/45/4/1,146/5,304 overturned. The linked '2025 Interoperability Report' PDF (bluecrossmn.widen.net) could not be fetched - blocked by robots.txt.", "source_sha256": null, "service_list_url": null, "service_list_items": null, "entity_id": "mcd:MN:blue-plus", "filing_unit": "medicaid_plan" } ] }