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
Jun 19, 2026
Summary
BCBS RI reminds specialists to stop submitting unnecessary prior authorization requests to PCP offices. Prior authorization is no longer required for 53 specific codes across all lines of business, and fully insured Commercial members do not require prior authorization for any service as of October 1, 2025.
Action Required
Immediately: Specialists must verify authorization requirements using the Prior Authorization tool on the provider portal before submitting requests to PCP offices. Check member eligibility and funding via bcbsri.com or EHR system using 270/271 file. Stop submitting prior authorization requests for the 53 waived codes and all fully insured Commercial services. Contact ProviderRelations@bcbsri.org for training if needed.