## Annual report

 ### The table data shows:

- Prior authorizations for services provided from January 1, 2025 to December 31, 2025
- How many prior authorization (PA) requests were authorized
- How many PA requests were denied. They are sorted by healthcare service, whether there was an appeal and whether the denial was upheld or reversed after the appeal.
- How many PA requests were submitted electronically and not by fax, email or another way



 

 

 

 

 ### 2025 Blue Cross plans

Service  
CategoryTotalApprovalsDenialsApproval  
RateElectronically Submitted Total AppealsUpheldOverturnedInpatient Behavioral Health2,183 2,075 10895%1,481523Inpatient Medical1,0641,056899%64710639 67Outpatient Behavioral Health3,398 3,067331 90%3,0751 1 0Outpatient Medical76,48169,3137,168 91%72,700520 181 339Prescription Drug105,26659,17546,09156%88,563573290283### 2025 Blue Plus plans

Service  
CategoryTotalApprovalsDenialsApproval  
RateElectronically Submitted Total AppealsUpheldOverturnedInpatient Behavioral Health7,4957,39010599%2,510211Inpatient Medical2,3552,16119492%1,503813645Outpatient Behavioral Health3,6903,6226898%2,411106 4Outpatient Medical113,706 107,4466,26094%109,1891,640 4941,146Prescription Drug5,432 2,8072,62552%4,98410,0944,7905,304

 

 

 

 

 

 

## Reasoning

## Reasons for denials

Prior authorization requests may have been denied for these reasons.



 

### Blue Cross and Blue Shield of Minnesota and Blue Plus:

- Change in treatment program
- Services are not considered to be medically necessary
- Patient did not meet prior authorization criteria
- Incomplete information submitted by the provider to the utilization review organization
- The patient is no longer covered by the plan



 

 

 



### Delegates:

- Did not meet prior authorization criteria
- Incomplete information submitted
- Inactive coverage/no plan coverage
- Change in treatment program
- Other



 

 

 



 

 



 

 

 

## Additional data

 ### 2025 Interoperability Report

Includes prior authorization approvals and denials data for Medicare plans



 

[View the report](https://bluecrossmn.widen.net/content/ur5toniz6n/original/2025-Interoperability-Report.pdf)

 

 

 

 

 

 

*This information meets Minnesota Statute 62M.18 requirements.*

*The linked Interoperability report meets Federal 422.122 Prior authorization requirements.*