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
May 1, 2024
We identified it
Jun 19, 2026
Summary
BCBSRI now requires providers to include a valid contact name and phone number on all medical necessity appeal requests to facilitate peer-to-peer discussions. Without this contact information, appeals will be reviewed solely on available clinical documentation if BCBSRI cannot schedule the required peer-to-peer after two attempts.
Action Required
Immediately: Update all medical necessity appeal request templates and workflows to include the full name and valid phone number of the person responsible for scheduling peer-to-peer discussions with BCBSRI Medical Directors. Train staff submitting appeals on this new requirement. Failure to provide contact information may result in appeals being decided without peer-to-peer consultation.