CommercialPrior AuthMedium 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
BCBSRI is eliminating prior authorization requirements for all services (except medications) when provided by credentialed PCPs to fully insured commercial members, effective October 1, 2025. This expands their May 2025 PCP burden reduction initiative and should streamline workflows and reduce care delays.
Action Required
By October 1, 2025: Primary care practices must verify they are credentialed as eligible PCPs with BCBSRI and update workflows to skip prior authorization requests for all non-medication services for fully insured commercial members. Continue using eligibility portal to verify member BCBSRI ID and confirm fully insured commercial status. Contact ProviderRelations@bcbsri.org for training on the new process.