Filing · f0237

Excellus BCBS Medicare D-SNP (HMO)

Excellus BlueCross BlueShield · Medicare Advantage · NY · H7524 · CY2025

In 2025 this plan received 2,327 standard prior authorization requests and denied 29.3% of them. The median for Medicare Advantage plans of comparable size is 10.9%.

Standard denial rate

29.3%

2,327 standard requests, 682 denied. 22.2% of appealed denials were overturned.

Requests and outcomes

	Total	Approved	Denied	Denial rate
Standard	2,327	1,645	682	29.3%
Expedited	29	24	5	17.2%

This payer also printed its own standard denial rate: 29.3%. The rate above is computed from the published counts, so the two can be compared.

Appeals of standard denials

Appeals filed	27
Denials overturned	6
Overturn rate	22.2%

Turnaround

	Mean	Median
Standard	1.8 d	1.0 d
Expedited	16.8 h	19.2 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. Contract H7524. Dual-eligible SNP; coded Medicare Advantage. 70.7% standard approval is far below the plan's other Medicare lines. Only 27 appeals against 682 denials.

Filing ID: f0237
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 Blue Option Plus (HARP)	12.9%