CommercialPrior AuthMedium impact
Reducing PCP Prior Authorizations
Blue Cross Blue Shield of Rhode Island·RI · Family Medicine, Internal Medicine, General Practice +4 more·Physician / Facility
Effective date
May 15, 2025
We identified it
Jun 19, 2026
Summary
BCBSRI is eliminating prior authorization requirements for credentialed PCPs on 62 CPT codes related to radiology, cardiology, and sleep studies effective May 15, 2025. A new provider portal process will allow PCPs to verify their eligibility for the waiver and help specialists confirm if an ordering physician qualifies.
Action Required
By May 15, 2025: Billing team must attend training sessions (May 7-14) or review materials on bcbsri.com to learn the new provider portal process for verifying PCP prior authorization waivers. Update workflows to check PCP eligibility before submitting prior authorization requests for the 62 affected CPT codes. Specialists must learn to identify eligible ordering PCPs through the new portal system.