State Detail
Rhode Island
2 plans reporting · CY 2025
Across 2 plans reporting in Rhode Island, standard prior authorization denial rates range from 4.9% to 15.7%, averaging 10.3%. 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 |
| Blue Cross Blue Shield of Rhode Island | ||||||||||||||||||||||||||
| BCBS Rhode IslandExchange Plans | Blue Cross Blue Shield of Rhode Island | 68,179 | 64,815 | 3,364 | 95.1% | 4.9% | — | — | — | 0.0% | 0.0% | 1.0 | 0.5 | 6,701 | 6,431 | 270 | 96.0% | 4.0% | — | — | — | 0.0% | 0.0% | 0.5 | 0.5 | View source ↗ |
| Point32Health | ||||||||||||||||||||||||||
| Tufts Health Plan RI Together - Medicaid MCO (Point32Health)Medicaid MCO | Point32Health | 352 | 297 | 55 | 84.4% | 15.7% | — | — | — | — | — | 5.7 | 3.8 | 90 | 80 | 10 | 88.9% | 11.1% | — | — | — | — | — | 0.7 | 0.7 | View source ↗ |
Standard Denial Rates by Plan
Similar Denial Rates