Filing · f0236

Excellus BCBS Managed Medicaid (MMC)

Excellus BlueCross BlueShield · Medicaid Managed Care · NY · CY2025

In 2025 this plan received 126,221 standard prior authorization requests and denied 15.0% of them. The median for Medicaid Managed Care plans of comparable size is 13.2%.

Standard denial rate

15.0%

126,221 standard requests, 18,983 denied. 18.4% of appealed denials were overturned.

Requests and outcomes

	Total	Approved	Denied	Denial rate
Standard	126,221	107,238	18,983	15.0%
Expedited	918	686	232	25.3%
Extended review, approved	17,716

This payer also printed its own standard denial rate: 15.0%. The rate above is computed from the published counts, so the two can be compared.

Appeals of standard denials

Appeals filed	705
Denials overturned	130
Overturn rate	18.4%

Turnaround

	Mean	Median
Standard	1.4 d	1.2 d
Expedited	16.8 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. Extended review total 20,067, of which 17,716 approved. Only 705 appeals against 18,983 standard denials (3.7% appeal rate).

Filing ID: f0236
Published: counts
Collector: blues

Other Excellus BlueCross BlueShield filings

Excellus BCBS Medicare PPO	6.2%
Excellus BCBS Medicare HMO	4.9%
Excellus BCBS Child Health Plus	14.5%
Excellus BCBS Blue Option Plus (HARP)	12.9%
Excellus BCBS Medicare D-SNP (HMO)	29.3%