Organization Detail
Baylor Scott & White Health Plan
3 plans across 1 state · Exchange PlansMedicare Advantage
Baylor Scott & White Health Plan reported prior authorization metrics for 3 Exchange Plans, Medicare Advantage plans across 1 state under CMS rule CMS-0057-F for calendar year 2025. Across those plans, Baylor Scott & White Health Plan processed 142,403 standard prior authorization requests. The average standard prior authorization denial rate was 10.9%, below the national average of 11.8%. When patients or providers appealed denied prior authorizations, 52% of appeals were overturned on average. Standard prior authorization decisions took an average of 1.1 days.
10.9%
Baylor Scott & White Health Plan Denial Rate
standard, avg across 3 plans
11.8%
National Average
all reporting plans
-0.9%
vs. National
near average
TX3 plans
| Plan | Requests | Approved | Denied | Appr % | Denial % ▼ | Appeals | Overturn % | Denied Appeal % | Appr Ext % | Denied Ext % | Mean Days | Med Days |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| BSW Marketplace (QHP)Exchange Plans | 75,462 | 65,908 | 9,554 | 87.3% | 12.7% | 2,419 | 61.2% | 38.8% | — | — | 0.7 | 0.0 |
| BSW SeniorCare Advantage PPOMedicare Advantage | 8,294 | 7,454 | 840 | 89.9% | 10.1% | 49 | 38.8% | 61.2% | 100.0% | 0.0% | 1.4 | 0.2 |
| BSW SeniorCare Advantage HMOMedicare Advantage | 58,647 | 52,855 | 5,792 | 90.1% | 9.9% | 345 | 55.9% | 44.1% | 96.0% | 4.0% | 1.3 | 0.2 |