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
Apr 23, 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 schedule mandatory peer-to-peer discussions. If BCBSRI cannot schedule the peer-to-peer after two attempts due to missing contact information, appeals will be reviewed based only on available clinical information.
Action Required
Immediately: Billing team and providers must update all medical necessity appeal request templates and procedures 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 on new requirement to avoid appeals being processed without peer-to-peer opportunity.