Organization Detail
Blue Cross and Blue Shield of Louisiana
4 plans across 1 state · Medicare AdvantageExchange Plans
Blue Cross and Blue Shield of Louisiana reported prior authorization metrics for 4 Medicare Advantage, Exchange Plans plans across 1 state under CMS rule CMS-0057-F for calendar year 2025. Across those plans, Blue Cross and Blue Shield of Louisiana processed 195,140 standard prior authorization requests. The average standard prior authorization denial rate was 3.7%, below the national average of 11.8%. When patients or providers appealed denied prior authorizations, 62.3% of appeals were overturned on average. Standard prior authorization decisions took an average of 0.3 days.
3.7%
Blue Cross and Blue Shield of Louisiana Denial Rate
standard, avg across 4 plans
11.8%
National Average
all reporting plans
-8.1%
vs. National
below average
LA4 plans
| Plan | Requests | Approved | Denied | Appr % | Denial % ▼ | Appeals | Overturn % | Denied Appeal % | Appr Ext % | Denied Ext % | Mean Days | Med Days |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Louisiana Blue QHP - HMOExchange Plans | 62,789 | 58,722 | 4,067 | 93.5% | 6.5% | 394 | 36.3% | 63.7% | — | — | 0.0 | 0.0 |
| Louisiana Blue QHP - LHSIC (PPO)Exchange Plans | 10,856 | 10,158 | 698 | 93.6% | 6.4% | 87 | 28.7% | 71.3% | — | — | 0.0 | 0.0 |
| Blue Advantage HMO (H6453) - Louisiana BlueMedicare Advantage | 89,303 | 88,405 | 898 | 99.0% | 1.0% | 38 | 84.2% | 15.8% | — | — | 0.0 | 0.0 |
| Blue Advantage PPO (H1248) - Louisiana BlueMedicare Advantage | 32,192 | 31,879 | 313 | 99.0% | 1.0% | 17 | 100.0% | 0.0% | — | — | 1.0 | 0.0 |