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APPEALS CORPUS

Five behavioral-health denial-intelligence analyses run against the appeals corpus on 2026-05-20. Cross-payer policy drift, temporal change, archival coverage. Internal exploratory — not for customer output.
5 ANALYSES BH DENIAL INTELLIGENCE 2026-05-20
Spravato Cross-Payer Drift
10 PAYERS · STEP-THERAPY HOTSPOT
FDA-label vs. payer-imposed restrictions for esketamine across 8 commercial/MA payers plus TX/NY Medicaid. Step-therapy is the biggest variance dimension; Premera is the structural outlier.
10 payers
17 criteria dims
Premera outlier
CA IMR · BH Temporal Drift
2002–2025 · n=446 · 34.5% OVERTURN
California Independent Medical Review behavioral-health appeals across 24 years. TMS dominates volume (n=145, 44% overturn); ABA the highest overturn rate (83%). Payer dimension intentionally omitted — IMR doesn't structure it.
446 cases
24 years
34.5% overturn
Payer Cross-Drift
307 ISSUERS · PY2025/PY2026
CMS Transparency in Coverage cross-payer BH drift. Cigna, Aetna, Molina are the operational worst actors; BCBS and Ambetter the most material PY2026 tighteners; Health First +1,449% likely a reporting artifact.
307 issuer-rows
8.1% baseline BH share
+1449% Health First
Aetna CPB Temporal Drift
2020–2025 · 10 TREATMENTS · WAYBACK
Year-over-year drift in Aetna Clinical Policy Bulletins for 10 BH treatments. TMS materially loosened in 2021; esketamine tightened in 2025 (5-year recency); MAT tightened in 2024; ECT and ABA frozen.
10 CPBs
49 snapshots
TMS 2021 biggest shift
Wayback Coverage Matrix
96 CELLS · 12 TX × 8 PAYERS
Archival viability for cross-payer corpus build. 31 of 96 cells viable (≥3 distinct years). Aetna dominant (10/12); Magellan single-doc covers 8/12; Anthem and BSCA un-archived — significant gap.
31/96 viable
Aetna 10/12
Anthem/BSCA 0/12
Generated 2026-05-20 · Source: stratum-corpus-data
Stratum Collective · Internal