Rhode Island: Start Here
Beginner guide for Rhode Island—HealthSource RI, OHIC external review, Ch. 27-18.9 PA & appeals.
Read guideState playbook
Rhode Island
State insurers, legislation, and appeal resources for patients and advocates in Rhode Island.
4 guides
Rhode Island Prior Authorization Law
Ch. 27-18.9—72-hour/15-day PA, primary-care pilot (2025–28), qualified reviewer rules.
Read guideRhode Island Health Insurance Appeals and Grievances
Ch. 27-18.9—72-hour/30-day appeals, provider consultation, path to OHIC IRO.
Read guideRhode Island External Review (OHIC / IRO)
Binding on plan—4-month filing, 45-day IRO decision, 72-hour expedited.
Read guidePrior auth & internal appeals
Match the plan on the member ID card. Use the denial letter for where to file appeals.
- Blue Cross Blue Shield of Rhode Island
- Neighborhood Health Plan of Rhode Island
- HealthSource RI
- Rhode Island Medicaid
External appeals
After internal appeal, for eligible Rhode Island fully insured plans only.
- OHIC — external review
- Medicaid — EOHHS fair hearing