CommercialPrior AuthHigh impact
Reminder to specialists – Reducing prior authorization requests
Blue Cross Blue Shield of Rhode Island·RI·Physician / Facility
Effective date
Oct 1, 2025
We identified it
Jul 1, 2026
Summary
Blue Cross Blue Shield Rhode Island is reminding specialists that they must use the provider portal tools to verify prior authorization requirements before submitting requests. Effective immediately, 53 CPT/HCPCS codes no longer require prior authorization across all lines of business, and as of October 1, 2025, fully insured commercial members require no prior authorization for any service. Specialists—not PCP offices—are responsible for determining authorization necessity.
Action Required
Immediately: All specialists must update their prior authorization submission processes to use the BCBS Rhode Island provider portal authorization tool before submitting any requests. Billing team must: (1) Verify the 53 codes that no longer require prior authorization and remove them from pre-authorization workflows; (2) Educate providers to check member product information via bcbsri.com or EHR 270/271 files to confirm eligibility and funding before requesting authorization; (3) Stop routing unnecessary prior authorization requests to PCP offices—this is now the specialist's responsibility to determine. By October 1, 2025: Ensure all fully insured commercial member claims do NOT include prior authorization requirements for any service. Contact ProviderRelations@bcbsri.org for training or the updated 53-code waiver list. Failure to comply will result in claim processing delays and potential denials when authorization is submitted unnecessarily.