{
  "name": "The Apellica External Review Index",
  "alternateName": "U.S. State External-Review Reversal Rates 2026",
  "description": "Public-record dataset of how often each U.S. jurisdiction's independent external-review program (or the HHS-administered federal process) overturns health-insurance denials, assembled from state Department of Insurance reports, state legislative reports, KFF, and CMS publications. Empty cells are left empty where the jurisdiction does not publish the figure; no values are extrapolated.",
  "version": "1.0",
  "datePublished": "2026-05-19",
  "resourcePackageUpdated": "2026-09-04",
  "license": "https://creativecommons.org/licenses/by/4.0/",
  "licenseName": "Creative Commons Attribution 4.0 International (CC-BY-4.0)",
  "attribution": "Apellica (2026). The Apellica External Review Index: U.S. State External-Review Reversal Rates 2026. v1.0. Released 2026-05-19; resource package updated 2026-09-04. CC-BY-4.0. https://apellica.com/external-review-index",
  "canonicalUrl": "https://apellica.com/external-review-index",
  "creator": {
    "name": "Apellica",
    "url": "https://apellica.com"
  },
  "corrections": "editorial@apellica.com",
  "spatialCoverage": "United States (50 states, District of Columbia, 5 U.S. territories)",
  "temporalCoverage": "2014/2025",
  "jurisdictionsCovered": 56,
  "jurisdictionsWithMeasuredRate": 14,
  "jurisdictionsWithoutPublishedRate": 42,
  "stateRunPrograms": 47,
  "hhsAdministered": 9,
  "fields": [
    {
      "name": "state",
      "type": "string",
      "description": "Jurisdiction name."
    },
    {
      "name": "state_abbrev",
      "type": "string",
      "description": "USPS / territory abbreviation."
    },
    {
      "name": "year",
      "type": "integer|null",
      "description": "Reporting year of the cited figure; null when no dated figure is published."
    },
    {
      "name": "regulator_name",
      "type": "string",
      "description": "External-review authority or administering body."
    },
    {
      "name": "regulator_url",
      "type": "url",
      "description": "Authority homepage."
    },
    {
      "name": "total_external_reviews",
      "type": "integer|null",
      "description": "Case count where the source publishes it; otherwise null."
    },
    {
      "name": "total_overturned_full_or_partial",
      "type": "integer|null",
      "description": "Overturned-in-full-or-part count where published; otherwise null."
    },
    {
      "name": "percent_overturned",
      "type": "decimal|null",
      "description": "Overturn/reversal rate as published by the source (0-1). Denominators differ by jurisdiction and are not directly comparable."
    },
    {
      "name": "system_type",
      "type": "enum",
      "description": "state-run | HHS-administered."
    },
    {
      "name": "source_document",
      "type": "url",
      "description": "Primary source URL for the cell."
    },
    {
      "name": "notes",
      "type": "string",
      "description": "Per-row methodology caveat, verbatim."
    }
  ],
  "caveats": [
    "Denominators are not comparable across jurisdictions (cases received vs. completed vs. completed-and-eligible).",
    "Some jurisdictions report a complaint-process reversal rate that is broader than strict IRO-only external review.",
    "Some figures are cumulative multi-year rates, not single-year.",
    "No national average is rolled up; no jurisdiction's missing value is imputed.",
    "Medicare Advantage IRE and workers'-compensation IMR data are excluded."
  ],
  "distributions": [
    {
      "name": "CSV",
      "encodingFormat": "text/csv",
      "url": "https://apellica.com/external-review-index/data"
    },
    {
      "name": "Methodology (markdown)",
      "encodingFormat": "text/markdown",
      "url": "https://apellica.com/external-review-index/methodology"
    },
    {
      "name": "Metadata descriptor (JSON)",
      "encodingFormat": "application/json",
      "url": "https://apellica.com/external-review-index/dataset.json"
    }
  ]
}