CommercialPrior AuthMedium impact
Information for PCPs on Rhode Island Prior Authorization Reform Act
Harvard Pilgrim Health Care·RI · Family Medicine, Internal Medicine, Pediatrics +2 more·Prior Authorization
Effective date
Oct 1, 2025
We identified it
Jun 20, 2026
Summary
Rhode Island's Prior Authorization Reform Act creates a 3-year pilot program (Oct 1, 2025 - Oct 1, 2028) that eliminates prior authorization requirements for certain primary care services ordered by in-network PCPs for Harvard Pilgrim Health Care Commercial and Tufts Health RITogether plan members. This applies only to services provided in the normal course of primary care treatment by qualified PCPs.
Action Required
Before Oct 1, 2025: Rhode Island primary care practices must verify PCP credentialing status with Harvard Pilgrim and Tufts networks, and ensure Medicaid enrollment if treating RITogether members. Update billing workflows to identify when prior authorization exemptions apply for routine primary care services. Review the insurer's FAQ and Rhode Island EOHHS website for specific eligible services and codes.