---
title: "Api Managed Care Reconciliation"
method: GET
path: "/api/managed-care/reconciliation"
---

# Api Managed Care Reconciliation

`GET /api/managed-care/reconciliation`

## Request

- Base URL: `https://www.oxfordledge.com` (the document declares no server; this is the origin it was published from)
- URL: `https://www.oxfordledge.com/api/managed-care/reconciliation`
- Auth: none declared

The quarterly reconciliation panel: per carrier, CMS parent rollup
(MA + PDP) vs carrier-REPORTED membership lines, deltas labeled with
the definition-basis flag. TIERED (OWNER ruling 1): plus and above;
anonymous 401, insufficient tier 402 via the TierGateException
handler. Honest-empty when the seed/store is absent.

## Response `200`

Successful Response

- ManagedCareReconciliationResponse: `GET /api/managed-care/reconciliation` -- the tiered decomposition analytic (OWNER ruling 1: reconciliation is tiered; require_min_tier('plus'), 402 semantics).
  - `available` boolean, required: False when no reconciliation rows exist.
  - `rows` ManagedCareReconciliationRow[], required: Per-carrier reconciliation, alphabetical by ticker ([] = honest-empty).
    - `ticker` string, required: Carrier ticker (UNH/HUM/CVS/ELV/CNC/MOH seed).
    - `parent_org` string, required: CMS parent-organization spelling used for the rollup.
    - `period_end` string, required: Carrier reporting period end (e.g. 2026-06-30).
    - `cms_report_month` string, required: CMS month anchoring the quarter end (month AFTER period_end -- the payment-cutoff convention the Phase-0 preview validated).
    - `carrier_total_medical_thousands` integer, nullable: Carrier-reported total medical membership, company definition.
    - `carrier_ma_thousands` integer, nullable: Carrier-reported MA line; null = not reported.
    - `carrier_medicaid_thousands` integer, nullable: Carrier-reported Medicaid line; null = not reported.
    - `carrier_pdp_thousands` integer, nullable: Carrier-reported stand-alone PDP line; null = not reported.
    - `cms_ma_enrollment` integer, nullable: CMS MA-family parent rollup (persons, latest vintage).
    - `cms_pdp_enrollment` integer, nullable: CMS PDP-family parent rollup (persons, latest vintage).
    - `ma_delta` integer, nullable: CMS MA rollup minus carrier MA line (persons).
    - `ma_delta_pct` number, nullable: ma_delta as a percent of the carrier line.
    - `pdp_delta` integer, nullable: CMS PDP rollup minus carrier PDP line.
    - `pdp_delta_pct` number, nullable: pdp_delta as a percent of the carrier line.
    - `ma_basis_differs` boolean, required: True when the two MA figures count different populations by definition (e.g. UNH's people-served line excludes ~1.76M CMS-contracted lives).
    - `pdp_basis_differs` boolean, required: True when the PDP bases differ (e.g. stand-alone vs incl employer-direct PDP).
    - `ma_basis_label` string, nullable: 'definition basis differs' when ma_basis_differs -- rendered beside the delta so the gap is never read as an error.
    - `pdp_basis_label` string, nullable: 'definition basis differs' when pdp_basis_differs.
    - `ma_definition_note` string, required: The carrier MA line's own definition basis, quoted from the filing.
    - `pdp_definition_note` string, required: The carrier PDP line's definition basis.
    - `medicaid_definition_note` string, required: The carrier Medicaid line's definition basis.
    - `total_medical_definition_note` string, required: The carrier total-membership definition basis.
    - `accession` string, required: EDGAR accession the carrier lines were read from.
    - `source_url` string, required: EDGAR filing index URL (provenance).
  - `as_of_period_end` string, nullable: Carrier reporting period the panel reconciles.
  - `provenance` string, required: Attribution: CMS monthly files (public domain) vs carrier EDGAR exhibits, accession-cited per row.
  - `methodology_note` string, required: How to read the panel: CMS and carrier figures are different measurement systems; where the definition basis differs the delta reflects scope, not error, and lines are never summed across programs.

---

[API](https://skmtc.dev/oxfordledge/apis/oxford-ledge-api.md) · [All operations](https://skmtc.dev/oxfordledge/apis/oxford-ledge-api/llms.txt) · [OpenAPI document](https://skmtc.dev/oxfordledge/apis/oxford-ledge-api/revisions/e832a1260f0b?raw)