CommercialAdministrativeHigh impact
Requirement to refer members to in-network providers
Blue Cross Blue Shield of Rhode Island·RI·Physician / Behavioral Health
Effective date
Jul 1, 2025
We identified it
Jun 19, 2026
Summary
BCBS Rhode Island now requires all contracted providers to refer members only to in-network providers for services like durable medical equipment, radiology, behavioral health, and laboratory services. Four specific laboratories (Accu Reference Lab, Quest Diagnostics, Total Toxicology, and U.S. Lab & Radiology) are confirmed as out-of-network and should not receive referrals.
Action Required
By July 1, 2025: All providers must verify network status before making referrals using BCBS RI's Find a Doctor tool. Immediately stop referring to the four listed out-of-network laboratories: Accu Reference Lab, Quest Diagnostics, Total Toxicology, and U.S. Lab & Radiology. Update referral workflows to include network verification step for all services including DME, radiology, behavioral health, and lab services. Failure to comply may result in claim processing issues.