Filing · f0367

Tufts Health One Care

Point32Health · Medicare-Medicaid Plan · MA · CY2025

In 2025 this plan received 9,942 standard prior authorization requests and denied 4.5% of them. The median for Medicare-Medicaid Plan plans of comparable size is 7.0%.

Standard denial rate

4.5%

9,942 standard requests, 445 denied.

Requests and outcomes

	Total	Approved	Denied	Denial rate
Standard	9,942	9,497	445	4.5%
Expedited	686	612	74	10.8%
Extended review, approved	0

This payer also printed its own standard denial rate: 4.5%. The rate above is computed from the published counts, so the two can be compared.

Appeals of standard denials

Appeals filed	—
Denials overturned	31
Overturn rate	—

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

Turnaround

	Mean	Median
Standard	4.0 d	2.7 d
Expedited	7.6 h	1.3 h

Source

https://www.tuftsmedicarepreferred.org/pa-cms-one-care-report

Verified % signs are literally printed on page next to counts (e.g. 'Request approved 9,497 9,942 95.5%'), not calculated. Document also prints 'approved after appeal: 31 (0.3%)' where the 0.3% denominator is total standard requests (9,942), not appeals filed — appeals_total (number of appeals filed) is not separately published, so std_appeals_total and std_appeal_overturn_pct are omitted to avoid implying an appeals-filed denominator. 'Approved after extension' = 0 for both standard and expedited per document; recorded once under ext_review_approved (standard bucket).

Filing ID: f0367
Published: counts
Collector: w3_newengland

Other Point32Health filings

Tufts Health Together with UMass Memorial Health	5.2%
Tufts Health Together with Cambridge Health Alliance (CHA)	4.0%
Tufts Health Together Managed Care Organization (MCO)	7.4%
Tufts Health RITogether	15.6%
Harvard Pilgrim Health Care – New Hampshire Exchange Local Choice	15.9%