CommercialPrior AuthHigh impact
IQ Updates
Blue Cross Blue Shield of Rhode Island·RI · Orthopedics, Neurosurgery, Pain Management +1 more·Physician / Facility
Effective date
Jul 1, 2024
We identified it
Jun 19, 2026
Summary
Blue Cross Blue Shield of Rhode Island is updating their online authorization tool effective July 1, 2024, with changes to InterQual criteria for several procedures including lumbar spine procedures, knee replacements, facet joint injections, spinal cord stimulators, and various durable medical equipment. These updates will affect prior authorization requirements for these specific services.
Action Required
By July 1, 2024: Billing and prior authorization staff must review the updated InterQual criteria in BCBSRI's online authorization tool for lumbar decompression/fusion procedures, knee replacements, facet joint injections, spinal cord stimulator insertions, power operative vehicles, speech generating devices, and pediatric/power wheelchairs. Update internal prior authorization checklists and documentation requirements to align with new criteria. Train staff on revised authorization requirements to prevent claim denials.