Blue Cross Blue Shield (BCBS) of Rhode Island has specific requirements for prior authorization, which can be found in the BCBSRI Prior Authorization Requirements and Updates section.
To initiate the prior authorization process, providers must submit a request through the BCBSRI online portal or by fax. The request must include the patient's demographic information, diagnosis, and treatment plan.
BCBSRI has a list of services that require prior authorization, including certain medications, procedures, and treatments. This list is subject to change, so it's essential for providers to regularly check the BCBSRI website for updates.
The prior authorization process typically takes 2-3 business days, but may be delayed if additional information is required.
Consider reading: Bcbs Arkansas Prior Authorization List
Prior Authorization Requirements
BCBS Rhode Island is making some significant changes to prior authorization requirements for primary care providers (PCPs). They're eliminating nearly 65% of prior authorization requirements by early 2025.
This change will affect commercial and Medicare plans, making it easier for PCPs to provide care to their patients. BCBSRI removed all prior authorization for outpatient behavioral services in 2018.
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PCPs will see a reduction in prior authorization requirements for radiology and cardiology services, which were among the most common orders that created additional work for them. These changes aim to help PCPs thrive and improve patient access to care.
If you need preauthorization for radiology services, you'll need to contact eviCore. You can contact them in one of three ways:
Check this out: Prior Authorization Services
BCBS RI Policy Updates
BCBS RI is making significant changes to its prior authorization requirements. By early 2025, they will be eliminating nearly 65% of these requirements for primary care providers.
Radiology and cardiology services are among the top orders that create additional work for PCPs, and BCBS RI is cutting these requirements. This change will apply across both commercial and Medicare plans.
BCBS RI President and CEO Martha Wofford hopes that reducing these authorizations will help PCPs thrive and improve patient access to care.
Frequently Asked Questions
What is the fax number for BCBS of Rhode Island prior authorization?
To request prior authorization, fax the completed form to 401-459-2503, and BCBSRI's BH staff will contact you within 3 business days with your authorization number.
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