{
    "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": "f0220",
            "parent_org": "Elevance Health",
            "plan_name": "Healthy Blue South Carolina (BlueChoice HealthPlan of South Carolina)",
            "contract_id": null,
            "coverage_type": "Medicaid Managed Care",
            "state": "SC",
            "reporting_period": "CY2025",
            "std_total": 55220,
            "std_approved": 39801,
            "std_denied": 15419,
            "std_denial_rate": 27.92,
            "std_denial_rate_printed": 27.9,
            "std_appeals_total": null,
            "std_appeals_overturned": 189,
            "std_appeal_overturn_rate": 0.34,
            "exp_total": 17822,
            "exp_approved": 15335,
            "exp_denied": 2487,
            "exp_denial_rate": 13.95,
            "ext_review_approved": 0,
            "std_tat_mean_days": 5.45,
            "std_tat_median_days": 5.1,
            "exp_tat_mean_hours": 52.8,
            "exp_tat_median_hours": 49.68,
            "reports_counts": true,
            "quality_flags": "clean",
            "error_count": 0,
            "warn_count": 0,
            "source_url": "https://www.healthybluesc.com/member-center/prior-authorization",
            "source_segment": "w3_southeast",
            "extraction_note": "Page states 'Data published by March 31, 2026, covering calendar year 2025.' Expedited turnaround was printed in DAYS (avg 2.2, median 2.07) rather than hours -- unusual for an 'expedited' category, printed as-is; converted x24 to hours per schema (52.8 / 49.68) and flagged here rather than silently normalized. Table also prints an expedited 'approved after appeal' count of 277 (1.6%), for which this schema has no expedited-appeals field -- recorded here instead of std_appeals_overturned. 'Approved after extended review' was printed as 0 for both the standard and expedited pools (single ext_review_approved field used to represent both). Content is embedded directly in page HTML; no separate PDF exists. Verified with two independent fetches returning identical figures.",
            "source_sha256": null,
            "service_list_url": null,
            "service_list_items": null,
            "entity_id": null,
            "filing_unit": null
        },
        {
            "filing_id": "f0402",
            "parent_org": "Molina Healthcare",
            "plan_name": "Molina Healthcare of South Carolina Medicaid",
            "contract_id": null,
            "coverage_type": "Medicaid Managed Care",
            "state": "SC",
            "reporting_period": "CY2025",
            "std_total": null,
            "std_approved": null,
            "std_denied": null,
            "std_denial_rate": 27,
            "std_denial_rate_printed": 27,
            "std_appeals_total": null,
            "std_appeals_overturned": null,
            "std_appeal_overturn_rate": 18,
            "exp_total": null,
            "exp_approved": null,
            "exp_denied": null,
            "exp_denial_rate": 11,
            "ext_review_approved": null,
            "std_tat_mean_days": 8,
            "std_tat_median_days": 9,
            "exp_tat_mean_hours": 21,
            "exp_tat_median_hours": 20,
            "reports_counts": false,
            "quality_flags": "info:appeals_not_reported; info:percentages_only",
            "error_count": 0,
            "warn_count": 0,
            "source_url": "https://www.molinahealthcare.com/providers/sc/medicaid/forms/fuf.aspx",
            "source_segment": "wave2",
            "extraction_note": "Percentages only. Standard mean (8 days) below median (9 days) and both exceed the 7-day standard.",
            "source_sha256": null,
            "service_list_url": null,
            "service_list_items": null,
            "entity_id": "mcd:SC:molina-healthcare-of-south-carolina",
            "filing_unit": "medicaid_plan"
        },
        {
            "filing_id": "f0131",
            "parent_org": "Centene",
            "plan_name": "Ambetter from Absolute Total Care (79222)",
            "contract_id": "79222",
            "coverage_type": "Marketplace QHP",
            "state": "SC",
            "reporting_period": "CY2025",
            "std_total": 99318,
            "std_approved": 78008,
            "std_denied": 21310,
            "std_denial_rate": 21.46,
            "std_denial_rate_printed": null,
            "std_appeals_total": 1646,
            "std_appeals_overturned": 935,
            "std_appeal_overturn_rate": 56.8,
            "exp_total": 4020,
            "exp_approved": 2938,
            "exp_denied": 1082,
            "exp_denial_rate": 26.92,
            "ext_review_approved": 38,
            "std_tat_mean_days": 4,
            "std_tat_median_days": 1,
            "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/absolute-total-care/ambetter/pdfs/SC_MKT_ABAbsoluteTotalCare_79222_MetricsSummary_R.pdf",
            "source_segment": "wave2",
            "extraction_note": "State inferred from the publishing brand page; PDF prints only 'MarketPlace'.",
            "source_sha256": null,
            "service_list_url": null,
            "service_list_items": null,
            "entity_id": "qhp:SC:79222",
            "filing_unit": "qhp_issuer"
        },
        {
            "filing_id": "f0025",
            "parent_org": "AmeriHealth Caritas Family of Companies",
            "plan_name": "First Choice by Select Health of South Carolina",
            "contract_id": null,
            "coverage_type": "Medicaid Managed Care",
            "state": "SC",
            "reporting_period": "CY2025",
            "std_total": 72229,
            "std_approved": 57563,
            "std_denied": 13195,
            "std_denial_rate": 18.27,
            "std_denial_rate_printed": 18.3,
            "std_appeals_total": null,
            "std_appeals_overturned": 944,
            "std_appeal_overturn_rate": null,
            "exp_total": 2123,
            "exp_approved": 1823,
            "exp_denied": 294,
            "exp_denial_rate": 13.85,
            "ext_review_approved": null,
            "std_tat_mean_days": 4,
            "std_tat_median_days": 1,
            "exp_tat_mean_hours": 15.83,
            "exp_tat_median_hours": 20,
            "reports_counts": true,
            "quality_flags": "error:std_counts_reconcile",
            "error_count": 1,
            "warn_count": 0,
            "source_url": "https://www.selecthealthofsc.com/member/info-for-you/prior-authorization-reporting",
            "source_segment": "aetna_ahc",
            "extraction_note": "Expedited appeals overturned: 47. Extended review published as a percentage only (standard 0.01%, expedited 0%), so ext_review_approved is null. Approved other than requested: 1,471 standard, 6 expedited. RECONCILIATION FLAG: 57,563 + 13,195 = 70,758 vs printed total 72,229. Expedited mean TAT (15.83 h) is shorter than the printed 20-hour median.",
            "source_sha256": null,
            "service_list_url": null,
            "service_list_items": null,
            "entity_id": "mcd:SC:first-choice-by-select-health",
            "filing_unit": "medicaid_plan"
        },
        {
            "filing_id": "f0412",
            "parent_org": "Molina Healthcare",
            "plan_name": "Molina Marketplace South Carolina",
            "contract_id": null,
            "coverage_type": "Marketplace QHP",
            "state": "SC",
            "reporting_period": "CY2025",
            "std_total": null,
            "std_approved": null,
            "std_denied": null,
            "std_denial_rate": 13,
            "std_denial_rate_printed": 13,
            "std_appeals_total": null,
            "std_appeals_overturned": null,
            "std_appeal_overturn_rate": 50,
            "exp_total": null,
            "exp_approved": null,
            "exp_denied": null,
            "exp_denial_rate": 10,
            "ext_review_approved": null,
            "std_tat_mean_days": 5,
            "std_tat_median_days": 4,
            "exp_tat_mean_hours": 25,
            "exp_tat_median_hours": 23,
            "reports_counts": false,
            "quality_flags": "info:appeals_not_reported; info:percentages_only",
            "error_count": 0,
            "warn_count": 0,
            "source_url": "https://www.molinamarketplace.com/marketplace/sc/en-us/Providers/Provider-Forms.aspx",
            "source_segment": "wave2",
            "extraction_note": "Percentages only. Entity named 'Molina Clinical Services, LLC' in the document; state attribution from page placement.",
            "source_sha256": null,
            "service_list_url": null,
            "service_list_items": null,
            "entity_id": "qhp:SC:42326",
            "filing_unit": "qhp_issuer"
        },
        {
            "filing_id": "f0320",
            "parent_org": "Humana",
            "plan_name": "Humana Healthy Horizons in South Carolina",
            "contract_id": null,
            "coverage_type": "Medicaid Managed Care",
            "state": "SC",
            "reporting_period": "2025",
            "std_total": 14667,
            "std_approved": 13074,
            "std_denied": 1593,
            "std_denial_rate": 10.86,
            "std_denial_rate_printed": 10.86,
            "std_appeals_total": 48,
            "std_appeals_overturned": 21,
            "std_appeal_overturn_rate": 43.75,
            "exp_total": 3799,
            "exp_approved": 1541,
            "exp_denied": 2258,
            "exp_denial_rate": 59.44,
            "ext_review_approved": 0,
            "std_tat_mean_days": 3,
            "std_tat_median_days": 2,
            "exp_tat_mean_hours": 10,
            "exp_tat_median_hours": 8,
            "reports_counts": true,
            "quality_flags": "clean",
            "error_count": 0,
            "warn_count": 0,
            "source_url": "https://assets.humana.com/is/content/humana/Humana_SC_Prior_Auth_Metrics_PlanYear2025pdf",
            "source_segment": "w5_humana",
            "extraction_note": "parsed from the published template by pipeline.preauth.extract (humana)",
            "source_sha256": "f1a886bffab79ab3181b3b6cc76e1ec2c9578211bde0d118d896b45ab6c6c03e",
            "service_list_url": "https://provider.humana.com/MedicaidPAL",
            "service_list_items": null,
            "entity_id": "mcd:SC:humana-healthy-horizons",
            "filing_unit": "medicaid_plan"
        }
    ]
}