Medicare AdvantageAdministrativeHigh impact
Post Acute Care Delegation
Blue Cross Blue Shield of Rhode Island·RI·Facility
Effective date
Mar 15, 2025
We identified it
Jun 19, 2026
Summary
Effective March 15, 2025, BCBSRI is delegating utilization management for post-acute care services (SNF, IRF, LTACH) to Carelon for Medicare Advantage members only. Providers must register for the new Carelon portal and submit authorization requests there instead of through BCBSRI for these services.
Action Required
By February 15, 2025: Register for the Carelon portal at https://providers.carelonmedicalbenefitsmanagement.com/postacute/provider-materials/ using access code CMBMRI2025. Attend mandatory one-hour orientation sessions covering authorization processes and portal training. By March 15, 2025: Begin submitting all prior authorization, concurrent, and retrospective review requests for Medicare Advantage SNF, IRF, and LTACH services through Carelon portal instead of BCBSRI. Continue using BCBSRI for Commercial members and Prospect for attributed Medicare Advantage members.