Filing · f0235

Excellus BCBS Child Health Plus

Excellus BlueCross BlueShield · CHIP Managed Care · NY · CY2025

In 2025 this plan received 18,319 standard prior authorization requests and denied 14.5% of them. The median for CHIP Managed Care plans of comparable size is 15.6%.

Standard denial rate

14.5%

18,319 standard requests, 2,652 denied. 14.3% of appealed denials were overturned.

Requests and outcomes

	Total	Approved	Denied	Denial rate
Standard	18,319	15,667	2,652	14.5%
Expedited	73	60	13	17.8%
Extended review, approved	1,529

This payer also printed its own standard denial rate: 14.5%. The rate above is computed from the published counts, so the two can be compared.

Appeals of standard denials

Appeals filed	112
Denials overturned	16
Overturn rate	14.3%

Turnaround

	Mean	Median
Standard	1.6 d	1.4 d
Expedited	14.4 h	2.4 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. Extended review total 1,768, of which 1,529 approved.

Filing ID: f0235
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 Blue Option Plus (HARP)	12.9%
Excellus BCBS Medicare D-SNP (HMO)	29.3%