Filing · f0031

Blue Cross Complete of Michigan

Blue Cross Blue Shield of Michigan · Medicaid Managed Care · MI · CY2025

In 2025 this plan received 243,159 standard prior authorization requests and denied 34.9% of them. The median for Medicaid Managed Care plans of comparable size is 13.2%.

Standard denial rate

34.9%

243,159 standard requests, 84,816 denied.

Requests and outcomes

	Total	Approved	Denied	Denial rate
Standard	243,159	158,307	84,816	34.9%
Expedited	11,241	9,318	1,921	17.1%

This payer also printed its own standard denial rate: 34.9%. The rate above is computed from the published counts, so the two can be compared.

Appeals of standard denials

Appeals filed	—
Denials overturned	893
Overturn rate	—

This filing publishes no appeal outcome. CMS-0057-F does not require one.

Turnaround

	Mean	Median
Standard	5.9 d	4.0 d
Expedited	31.8 h	24.0 h

Source

https://www.mibluecrosscomplete.com/important-information/prior-authorization/

OUTLIER: 34.90% standard denial rate is several times higher than any other filing in this segment - worth verifying against the plan's own PDF before use. Approved+denied (158,307+84,816=243,123) is 36 short of the stated 243,159 total, which matches the separately reported 36 'approved other than requested' (2 for expedited). Appeals: only overturn COUNTS are published (893 standard, 60 expedited) with no appeal denominator, so std_appeals_total and overturn pct are null. Extended review published only as a percentage of approved requests (1.10% standard, 0.20% expedited), so ext_review counts are null. This is the BCBSM Medicaid subsidiary; no separate BCBSM commercial/MA filing was located.

Filing ID: f0031
Published: counts
Collector: blues