{
  "id": "mn-001",
  "payer_family": "medicare_advantage",
  "payer_id": "MA-PLAN-A",
  "denial_reason_code": "medical_necessity",
  "denial_reason_text": "Inpatient level of care not medically necessary; observation appropriate",
  "stay_midnights": 2,
  "ordered_as_inpatient": true,
  "two_midnight_expectation_documented": true,
  "interqual_or_milliman_met": true,
  "payer_criteria_stricter_than_traditional_medicare": true,
  "prior_auth_obtained": false,
  "prior_auth_required_by_contract": false,
  "drg_weight_band": "high",
  "allowed_amount_usd_band": "25000_50000",
  "historical_overturn_rate_same_payer_reason": 0.62,
  "days_since_discharge": 18,
  "timely_filing_risk": "low"
}