Medicare AdvantageAdministrativeHigh 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
Effective March 15, 2025, BCBSRI is delegating utilization management for skilled nursing facilities (SNF), inpatient rehabilitation facilities (IRF), and long-term acute care hospitals (LTACH) to Carelon for Medicare Advantage members. Providers must register for the new Carelon portal to submit prior authorization, concurrent reviews, and retrospective reviews.
Action Required
By March 15, 2025: Register for the Carelon portal at https://providers.carelonmedicalbenefitsmanagement.com/postacute/provider-materials/ using access code CMBMRI2025. Billing team and admissions staff must attend orientation sessions starting February 15, 2025 to learn the new authorization process for SNF, IRF, and LTACH services. Update workflows to submit all Medicare Advantage utilization management requests through Carelon portal instead of BCBSRI. Note: Prospect members continue using existing process at 1-844-762-9231.