Filing · f0234

Excellus BCBS Blue Option Plus (HARP)

Excellus BlueCross BlueShield · Medicaid Managed Care · NY · CY2025

In 2025 this plan received 17,806 standard prior authorization requests and denied 12.9% of them. The median for Medicaid Managed Care plans of comparable size is 13.2%.

Standard denial rate

12.9%

17,806 standard requests, 2,294 denied. 10.0% of appealed denials were overturned.

Requests and outcomes

	Total	Approved	Denied	Denial rate
Standard	17,806	15,512	2,294	12.9%
Expedited	108	99	9	8.3%
Extended review, approved	3,224

This payer also printed its own standard denial rate: 12.9%. The rate above is computed from the published counts, so the two can be compared.

Appeals of standard denials

Appeals filed	100
Denials overturned	10
Overturn rate	10.0%

Turnaround

	Mean	Median
Standard	1.3 d	1.0 d
Expedited	12.0 h	7.2 h

Source

https://www.excellusbcbs.com/documents/d/global/excellusmetrics2025

Expedited decision times were published in DAYS in this report and converted to hours (x24). Extended-review row reports a total and an approved count only, so ext_review_denied is left null (the total is given in this note rather than derived). Document is titled 'Prior Authorization Metrics 2025' and carries a publication date of January 27, 2026. Health and Recovery Program (HARP). Extended review total 3,684, of which 3,224 approved.

Filing ID: f0234
Published: counts
Collector: blues

Other Excellus BlueCross BlueShield filings

Excellus BCBS Managed Medicaid (MMC)	15.0%
Excellus BCBS Medicare PPO	6.2%
Excellus BCBS Medicare HMO	4.9%
Excellus BCBS Child Health Plus	14.5%
Excellus BCBS Medicare D-SNP (HMO)	29.3%