CommercialAdministrativeLow impact
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
Nov 1, 2024
We identified it
Jun 19, 2026
Summary
BCBSRI has updated their Access to Care Standards defining which providers qualify as Primary Care Providers (PCPs) and establishing access/monitoring standards for member accessibility to PCPs, behavioral health providers, and specialists. This policy clarifies that PCPs must be board-certified physicians in internal medicine, pediatrics, or family medicine, with some nurse practitioners, physician assistants, and Ob/Gyns also qualifying under state law.
Action Required
Review current PCP designations in billing system to ensure they meet BCBSRI's definition requirements. Verify that any nurse practitioners, physician assistants, or Ob/Gyns serving as PCPs are properly licensed and certified per state law. No immediate billing changes required, but ensure PCP assignments align with updated standards.