BCBS AFFILIATENYPBM: Express Scripts

Excellus BCBS (Upstate NY) Prior Authorization Guide

Submit prior authorization requests and appeal denials with Excellus BCBS. Phone numbers, fax numbers, appeal deadlines, step therapy override rights, and clinical documentation tips for NY providers.

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Prior Authorization Contacts

PA PHONE

1-800-363-4658

PA FAX

1-585-238-4014

TURNAROUND

14 days standard, 72h expedited

TIMELY FILING

120 days

APPEALS MAILING ADDRESS

Excellus BCBS, Attn: Grievance and Appeals, PO Box 22999, Rochester, NY 14692

Common Denial Reasons

⚠ Excellus Medical Policy criteria not met
⚠ Step therapy required
⚠ Non-preferred formulary status
⚠ Specialty pharmacy routing

Step Therapy Requirements & Override Rights

Excellus BCBS serves upstate New York. NY S7056 (2020) provides step therapy override rights — 72 hour urgent response required. For biologics, typically requires 3-month DMARD trial.

Tips for Excellus BCBS Submissions

1. Excellus serves upstate NY (not NYC metro — that's Empire/Anthem)
2. NY S7056 provides step therapy override rights
3. Submit via Excellus provider portal
4. Express Scripts is the PBM

External Review Authority

If Excellus BCBS denies your final internal appeal, you have the right to request an external review through: New York State Department of Financial Services external review.

External review decisions are binding on the insurer.