CommercialPrior AuthHigh impact
PA PCP Reduction for all services (except medications) effective October 1, 2025
Blue Cross Blue Shield of Rhode Island·RI · Family Medicine, Internal Medicine, General Practice +1 more·Provider Update
Effective date
Oct 1, 2025
We identified it
Jun 19, 2026
Summary
Effective October 1, 2025, BCBS Rhode Island credentialed PCPs no longer need to submit prior authorization requests for any admission, service, treatment, or procedure (except medications) for fully insured Commercial members only. This change is designed to simplify workflows and reduce delays in patient care.
Action Required
By October 1, 2025: Primary care providers credentialed with BCBSRI must update workflows to stop submitting prior authorization requests for all services except medications for fully insured Commercial members. Continue using eligibility verification system to confirm member's BCBSRI ID and fully insured commercial status before proceeding without prior auth. Contact ProviderRelations@bcbsri.org for personalized training on the new process.