Medicare AdvantageAdministrativeMedium impact
Post acute care delegation
Blue Cross Blue Shield of Rhode Island·RI · PM&R (Physical Medicine & Rehab)·Facility
Effective date
Mar 15, 2025
We identified it
Jun 19, 2026
Summary
BCBSRI is delegating utilization management for skilled nursing facilities, inpatient rehabilitation facilities, and long-term acute care hospitals to Carelon for Medicare Advantage members effective March 15, 2025. Providers must register for the Carelon portal to submit prior authorization, concurrent, and retrospective review requests.
Action Required
By March 15, 2025: Register for the Carelon portal at https://providers.carelonmedicalbenefitsmanagement.com/postacute/provider-materials/ using access code CMBMRI2025. Attend orientation sessions starting February 15, 2025 to learn authorization processes and clinical documentation requirements. Update workflows to submit all Medicare Advantage SNF, IRF, and LTACH authorization requests through Carelon portal instead of BCBSRI. Note: Prospect members continue using existing process at 1-844-762-9231.