Filing · f0026

Blue Cross & Blue Shield of Rhode Island (all impacted lines combined)

Blue Cross & Blue Shield of Rhode Island · Multiple (combined) · RI · CY2025

In 2025 this plan received 68,179 standard prior authorization requests and denied 4.9% of them. The median for Multiple (combined) plans of comparable size is 6.3%.

Standard denial rate

4.9%

68,179 standard requests, 3,364 denied.

Requests and outcomes

	Total	Approved	Denied	Denial rate
Standard	68,179	64,815	3,364	4.9%
Expedited	6,701	6,431	270	4.0%
Extended review, approved	0

This payer also printed its own standard denial rate: 4.9%. The rate above is computed from the published counts, so the two can be compared.

Appeals of standard denials

Appeals filed	—
Denials overturned	708
Overturn rate	—

This filing publishes no appeal outcome. CMS-0057-F does not require one.

Turnaround

	Mean	Median
Standard	1.0 d	—
Expedited	—	—

Source

https://www.bcbsri.com/sitefiles/bcbsri-interoperability-metrics

coverage_type does NOT fit the required enum: BCBSRI publishes ONE combined set of figures spanning MA, Medicaid managed care, CHIP managed care and QHP business, with no per-plan or per-contract breakout, so the value is recorded as 'Multiple (combined)' rather than guessing a single line of business. Only the appeal OVERTURN count is published (708 approved after appeal); no appeal denominator, so std_appeals_total and overturn pct are null. Median standard TAT and both expedited TATs are printed as '<1 day' and are therefore null; standard mean is printed as '1 day'.

Filing ID: f0026
Published: counts
Collector: blues