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Access to care standards for all providers
Blue Cross Blue Shield of Rhode Island·RI · Family Medicine, Internal Medicine, Pediatrics +1 more·Provider Update
Effective date
Jul 1, 2025
We identified it
Jun 19, 2026
Summary
BCBSRI has updated its Access to Care Standards effective July 1, 2025, defining primary care provider (PCP) requirements and establishing access standards for PCPs, behavioral health providers, and specialists. This policy clarifies which providers qualify as PCPs and their responsibility for coordinating overall healthcare for BCBSRI members.
Action Required
By July 1, 2025: Review current PCP designations to ensure compliance with BCBSRI definitions (board-certified MDs/DOs in internal medicine, pediatrics, or family medicine, plus qualified nurse practitioners, physician assistants, and some OB/Gyns providing primary care). Update provider credentialing records and ensure access to care standards are met for member coordination requirements.