CommercialAdministrativeMedium impact
Reminder: Medical necessity appeals (including level of care appeals) – contact information needed
Blue Cross Blue Shield of Rhode Island·RI·Physician / Facility
Effective date
Jun 1, 2024
We identified it
Jun 19, 2026
Summary
BCBSRI requires providers to include a valid contact name and phone number on all medical necessity appeal requests to facilitate peer-to-peer discussions. If contact information is missing and BCBSRI cannot schedule the peer-to-peer after two attempts, the appeal will be reviewed solely based on available clinical information.
Action Required
Immediately: Update all medical necessity appeal request forms and templates to include fields for full name and valid phone number of the person responsible for scheduling peer-to-peer discussions. Train billing team and providers on new requirement. Ensure all future appeals include this contact information to avoid appeals being reviewed without peer-to-peer opportunity.