{
    "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": "f0145",
            "parent_org": "Centene",
            "plan_name": "Ambetter of Tennessee",
            "contract_id": null,
            "coverage_type": "Marketplace QHP",
            "state": "TN",
            "reporting_period": "CY2025",
            "std_total": 104566,
            "std_approved": 80766,
            "std_denied": 23800,
            "std_denial_rate": 22.76,
            "std_denial_rate_printed": 22.76,
            "std_appeals_total": 3238,
            "std_appeals_overturned": 2218,
            "std_appeal_overturn_rate": 68.5,
            "exp_total": 2475,
            "exp_approved": 2063,
            "exp_denied": 412,
            "exp_denial_rate": 16.65,
            "ext_review_approved": null,
            "std_tat_mean_days": 2,
            "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/ambettertn/pdfs/TN_MKT_ABofTN_70111_MetricsSummary_R.pdf",
            "source_segment": "w3_qhp",
            "extraction_note": "Issuer ID 70111. Expedited appeals: 148 total, 93 overturned (62.84%). 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:TN:70111",
            "filing_unit": "qhp_issuer"
        },
        {
            "filing_id": "f0436",
            "parent_org": "Oscar Health",
            "plan_name": "Oscar Health - Tennessee",
            "contract_id": "23552",
            "coverage_type": "Marketplace QHP",
            "state": "TN",
            "reporting_period": "CY2025",
            "std_total": null,
            "std_approved": null,
            "std_denied": null,
            "std_denial_rate": 11.89,
            "std_denial_rate_printed": 11.89,
            "std_appeals_total": null,
            "std_appeals_overturned": null,
            "std_appeal_overturn_rate": 47.41,
            "exp_total": null,
            "exp_approved": null,
            "exp_denied": null,
            "exp_denial_rate": 26.66,
            "ext_review_approved": null,
            "std_tat_mean_days": 2.3,
            "std_tat_median_days": 0.7,
            "exp_tat_mean_hours": 21.6,
            "exp_tat_median_hours": 21.6,
            "reports_counts": false,
            "quality_flags": "info:appeals_not_reported; info:percentages_only",
            "error_count": 0,
            "warn_count": 0,
            "source_url": "https://assets.ctfassets.net/plyq12u1bv8a/1ddRMANcB5i2BcR8rc8Nom/4f229a8c35b54e64010b83cc23d3df0d/PY2025_TN_23552.pdf",
            "source_segment": "marketplace",
            "extraction_note": "Percentages only.",
            "source_sha256": null,
            "service_list_url": null,
            "service_list_items": null,
            "entity_id": "qhp:TN:23552",
            "filing_unit": "qhp_issuer"
        },
        {
            "filing_id": "f0225",
            "parent_org": "Elevance Health",
            "plan_name": "Wellpoint Tennessee (TennCare)",
            "contract_id": null,
            "coverage_type": "Medicaid Managed Care",
            "state": "TN",
            "reporting_period": "CY2025",
            "std_total": null,
            "std_approved": null,
            "std_denied": null,
            "std_denial_rate": 8.5,
            "std_denial_rate_printed": 8.5,
            "std_appeals_total": null,
            "std_appeals_overturned": null,
            "std_appeal_overturn_rate": 19.5,
            "exp_total": null,
            "exp_approved": null,
            "exp_denied": null,
            "exp_denial_rate": 9.7,
            "ext_review_approved": null,
            "std_tat_mean_days": 3,
            "std_tat_median_days": 1,
            "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/tennessee/tn_medicaid_chip_priorauthsmetrics.pdf",
            "source_segment": "wave2",
            "extraction_note": "Percentages only; combined Medicaid and CHIP book.",
            "source_sha256": null,
            "service_list_url": null,
            "service_list_items": null,
            "entity_id": "mcd:TN:wellpoint",
            "filing_unit": "medicaid_plan"
        },
        {
            "filing_id": "f0525",
            "parent_org": "UnitedHealth Group",
            "plan_name": "Tennessee TennCare",
            "contract_id": null,
            "coverage_type": "Medicaid Managed Care",
            "state": "TN",
            "reporting_period": "CY2025",
            "std_total": 104271,
            "std_approved": 97454,
            "std_denied": 6817,
            "std_denial_rate": 6.54,
            "std_denial_rate_printed": null,
            "std_appeals_total": null,
            "std_appeals_overturned": 215,
            "std_appeal_overturn_rate": null,
            "exp_total": 6835,
            "exp_approved": 6592,
            "exp_denied": 243,
            "exp_denial_rate": 3.56,
            "ext_review_approved": null,
            "std_tat_mean_days": 0,
            "std_tat_median_days": 3,
            "exp_tat_mean_hours": 0,
            "exp_tat_median_hours": 9.6,
            "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:TN:unitedhealthcare-community-plan",
            "filing_unit": "medicaid_plan"
        }
    ]
}