State Detail
New Mexico
1 plan reporting · CY 2025
Across 1 plan reporting in New Mexico, standard prior authorization denial rates range from 12.8% to 12.8%, averaging 12.8%. Among plans reporting appeal outcomes, 76.3% of appealed denials are overturned. All data is from mandatory CMS-0057-F disclosures for calendar year 2025.
Plan Comparison
| Standard | Expedited | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Plan | Org | Requests | Approved | Denied | Appr % | Denial % ▼ | Appeals | Overturn % | Denied Appeal % | Appr Ext % | Denied Ext % | Mean Days | Med Days | Requests | Approved | Denied | Appr % | Denial % | Appeals | Overturn % | Denied Appeal % | Appr Ext % | Denied Ext % | Mean Days | Med Days | Source |
| Health Care Service Corporation | ||||||||||||||||||||||||||
| BCBS New Mexico Medicare Advantage (HCSC)Medicare Advantage | Health Care Service Corporation | — | — | — | 87.3% | 12.8% | — | 76.3% | 23.8% | — | — | 1.8 | 0.6 | — | — | — | 79.8% | 20.3% | — | — | — | — | — | 1.6 | 1.3 | View source ↗ |
Standard Denial Rates by Plan
Appeals Analysis
Plans in the upper-right deny frequently and have high overturn rates — suggesting inappropriate denials.
Similar Denial Rates