{ "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": "f0138", "parent_org": "Centene", "plan_name": "Ambetter from NH Healthy Families", "contract_id": null, "coverage_type": "Marketplace QHP", "state": "NH", "reporting_period": "CY2025", "std_total": 15855, "std_approved": 12191, "std_denied": 3664, "std_denial_rate": 23.11, "std_denial_rate_printed": 23.11, "std_appeals_total": 604, "std_appeals_overturned": 491, "std_appeal_overturn_rate": 81.29, "exp_total": 612, "exp_approved": 423, "exp_denied": 189, "exp_denial_rate": 30.88, "ext_review_approved": null, "std_tat_mean_days": 2, "std_tat_median_days": 0, "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/NH%20Healthy%20Families/ambetter/PDFs/NH_MKT_NHHealthyFamilies_75841_MetricsSummary_R.pdf", "source_segment": "w3_qhp", "extraction_note": "Issuer ID 75841. Expedited appeals: 28 total, 23 overturned (82.14%). Expedited TAT printed in days (mean 1, median 0); converted to hours (24h/0h) - native unit was days.", "source_sha256": null, "service_list_url": null, "service_list_items": null, "entity_id": "qhp:NH:75841", "filing_unit": "qhp_issuer" }, { "filing_id": "f0022", "parent_org": "AmeriHealth Caritas Family of Companies", "plan_name": "AmeriHealth Caritas New Hampshire", "contract_id": null, "coverage_type": "Medicaid Managed Care", "state": "NH", "reporting_period": "CY2025", "std_total": 17385, "std_approved": 13815, "std_denied": 3265, "std_denial_rate": 18.78, "std_denial_rate_printed": 18.78, "std_appeals_total": null, "std_appeals_overturned": 316, "std_appeal_overturn_rate": null, "exp_total": 934, "exp_approved": 778, "exp_denied": 129, "exp_denial_rate": 13.81, "ext_review_approved": null, "std_tat_mean_days": 5.74, "std_tat_median_days": 6, "exp_tat_mean_hours": 49.95, "exp_tat_median_hours": 32, "reports_counts": true, "quality_flags": "error:std_counts_reconcile; error:exp_counts_reconcile", "error_count": 2, "warn_count": 0, "source_url": "https://www.amerihealthcaritasnh.com/member/rights/prior-authorization-reporting", "source_segment": "aetna_ahc", "extraction_note": "Expedited appeals overturned: 12. Extended review reported as a percentage only (standard 1.6%, expedited 0%), so ext_review_approved is null. Approved-other-than-requested: 305 standard (1.75%), 27 expedited (2.89%). RECONCILIATION FLAG: 13,815 + 3,265 = 17,080 vs printed total 17,385.", "source_sha256": null, "service_list_url": null, "service_list_items": null, "entity_id": "mcd:NH:amerihealth-caritas-of-new-hampshire", "filing_unit": "medicaid_plan" }, { "filing_id": "f0440", "parent_org": "Point32Health", "plan_name": "Harvard Pilgrim Health Care – New Hampshire Exchange Local Choice", "contract_id": null, "coverage_type": "Marketplace QHP", "state": "NH", "reporting_period": "CY2025", "std_total": 182, "std_approved": 150, "std_denied": 29, "std_denial_rate": 15.93, "std_denial_rate_printed": 15.9, "std_appeals_total": null, "std_appeals_overturned": 0, "std_appeal_overturn_rate": null, "exp_total": 66, "exp_approved": 60, "exp_denied": 6, "exp_denial_rate": 9.09, "ext_review_approved": 0, "std_tat_mean_days": 0.72, "std_tat_median_days": 0.25, "exp_tat_mean_hours": 12.9, "exp_tat_median_hours": 3.2, "reports_counts": true, "quality_flags": "error:std_counts_reconcile", "error_count": 1, "warn_count": 0, "source_url": "https://www.tuftsmedicarepreferred.org/pa-cms-nh-exchange-report", "source_segment": "w3_newengland", "extraction_note": "Standard-request turnaround is printed on the page in HOURS, not days (verified verbatim: 'Mean (Average) Time: 17.4 hours', 'Median (Middle) Time: 5.9 hours'), unlike every other Point32Health filing in this file which prints standard TAT in days. Converted hours->days here (17.4/24=0.725, 5.9/24=0.246) to fit the std_tat_*_days field; raw printed hour values were 17.4 mean / 5.9 median. Also: printed std_approved (150) + std_denied (29) = 179, not the printed std_total of 182 — recorded exactly as printed; the 3-unit gap is unexplained by the document.", "source_sha256": null, "service_list_url": null, "service_list_items": null, "entity_id": "qhp:NH:59025", "filing_unit": "qhp_issuer" }, { "filing_id": "f0166", "parent_org": "Centene", "plan_name": "NH Healthy Families", "contract_id": null, "coverage_type": "Medicaid Managed Care", "state": "NH", "reporting_period": "CY2025", "std_total": 39685, "std_approved": 33320, "std_denied": 5310, "std_denial_rate": 13.38, "std_denial_rate_printed": null, "std_appeals_total": null, "std_appeals_overturned": null, "std_appeal_overturn_rate": null, "exp_total": 730, "exp_approved": 693, "exp_denied": 37, "exp_denial_rate": 5.07, "ext_review_approved": 0, "std_tat_mean_days": 3.1, "std_tat_median_days": 0, "exp_tat_mean_hours": 45.3, "exp_tat_median_hours": 3.3, "reports_counts": true, "quality_flags": "error:std_counts_reconcile; info:appeals_not_reported", "error_count": 1, "warn_count": 0, "source_url": "https://www.nhhealthyfamilies.com/content/dam/centene/NH%20Healthy%20Families/Medicaid/pdfs/NHHF_Prior_Authorization_Data_Metrics_Report_2025.pdf", "source_segment": "wave2", "extraction_note": "Denials labeled 'denied (including partial)'. Approved + denied (38,630) does not reconcile to the printed 39,685 total. No appeals data published.", "source_sha256": null, "service_list_url": null, "service_list_items": null, "entity_id": "mcd:NH:new-hampshire-healthy-families", "filing_unit": "medicaid_plan" } ] }