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Requirement to refer members to in-network providers
Effective date
Oct 1, 2026
Identified
Oct 1, 2026
Summary
BCBSRI is enforcing a requirement that all participating providers must refer members exclusively to in-network providers for all services including durable medical equipment, radiology, behavioral health, and laboratory/pathology services. The policy identifies four specific laboratories (Accu Reference Lab, Quest Diagnostics, Total Toxicology, U.S. Lab & Radiology, Inc.) that do NOT participate in BCBSRI's network and must be avoided for referrals.
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What to do
Action · 6 steps
01Effective October 1, 2026.
02Billing team and providers must immediately stop referring BCBSRI members to out-of-network providers, laboratories, radiology facilities, behavioral health providers, and DME suppliers.
03Before making any referral, providers must verify network participation using BCBSRI's Find a Doctor tool.
04Update referral protocols, encounter forms, and EMR templates to mandate in-network verification prior to referral completion.
05Specifically prohibit referrals to: Accu Reference Lab, Quest Diagnostics, Total Toxicology, and U.S. Lab & Radiology, Inc.
06Train all clinical and administrative staff on the new requirement.
If missed: Failure to comply will result in claims being processed as out-of-network with potential claim denials and member balance billing issues.
Original notice
Requirement to refer members to in-network providers
bcbsri.com · Always check the source before changing claims.
Related changes
See all Blue Cross Blue Shield of Rhode Island changes →Requirement to refer members to in-network providersHighEffective Jul 1, 2026 · Physician / Behavioral HealthOctober 2017MediumNo effective date · Provider UpdateRequirement to refer members to in-network providers for all BCBSRI productsHighEffective May 1, 2019 · Provider UpdateRequirement to refer members to in-network providers for all BCBSRI productsHighEffective Jun 1, 2019 · Provider UpdateBrowse every Blue Cross Blue Shield of Rhode Island change in the policy list