Summary
Blue Cross Blue Shield Rhode Island (BCBSRI) will update InterQual Criteria for CP (Procedures) related to Unicondylar or Patellofemoral Knee Replacement effective January 1, 2027. Billing and clinical teams should obtain the updated criteria from ProviderRelations@bcbsri.org to ensure compliance with new utilization review requirements.
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What to do
by Jan 1, 2027 · 2 steps
01Billing and clinical teams should contact ProviderRelations@bcbsri.org to request a copy of the updated InterQual Criteria for Unicondylar and Patellofemoral Knee Replacement procedures.
02Review and implement the new criteria in prior authorization workflows and clinical decision support systems to ensure compliance with BCBSRI requirements for these procedures.
Original notice
InterQual updates
bcbsri.com · Always check the source before changing claims.