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Blue Cross Blue Shield of Rhode IslandCommercial · Prior Auth · Provider Update · RI · Physical Therapy, Occupational TherapyHigh impact

PT/OT prior authorization to expand on January 1, 2027

Act
by Jan 1, 2027
Effective date
Jan 1, 2027
Identified
Oct 31, 2026

Summary

Effective January 1, 2027, BCBSRI will expand eviCore's prior authorization management to include physical and occupational therapy services for fully insured commercial members. Notification will be required for PT/OT visits 1–14 per episode of care; prior authorization will be required beginning with the 15th visit. All affected codes will be outlined in the updated medical policy 'Prior Authorization of Physical and Occupational Therapy Services.'

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What to do

by Jan 1, 2027 · 9 steps
01Billing team must implement prior authorization workflows for PT/OT services through eviCore for fully insured commercial plans.
02Update billing system to require notification (not prior auth) for PT/OT visits 1–14 per episode of care.
03Update billing system to require prior authorization for PT/OT visits 15 and beyond per episode of care.
04Review the updated medical policy 'Prior Authorization of Physical and Occupational Therapy Services' to identify all affected PT/OT codes.
05Train front desk and clinical staff on the new notification and authorization requirements.
06Verify member benefit limits on the BCBSRI provider portal before submitting claims, as fully insured commercial plans have different limits.
07Contact ProviderRelations@bcbsri.org if assistance is needed locating benefit limits on the portal.
08For eviCore portal questions, contact portal.support@evicore.com or 1-800-646-0418 (Option 2).
09eviCore will conduct educational webinars in December 2026 to demonstrate authorization processes and timeframes; registration details are available from BCBSRI.

Original notice

PT/OT prior authorization to expand on January 1, 2027
bcbsri.com · Always check the source before changing claims.
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Related policy hubs

Blue Cross Blue Shield of Rhode Island policiesRI policy changesPhysical TherapyOccupational Therapy

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