CommercialPrior AuthMedium impact
MHK updates
Blue Cross Blue Shield of Rhode Island·RI · Orthopedics, General Surgery, Oncology +1 more·Physician / Facility
Effective date
Jan 1, 2024
We identified it
Jun 19, 2026
Summary
BCBSRI is updating their MHK (Medical Home Kit) InterQual subsets effective January 1, 2024, affecting criteria for lumbar spine procedures, bariatric surgery, and several molecular diagnostic tests. These updates will change prior authorization and coverage determination criteria for these specific procedure categories.
Action Required
By January 1, 2024: Review and update prior authorization processes for lumbar decompression/fusion procedures, bariatric/metabolic surgery, and molecular diagnostic testing including BCR-ABL1, CFTR, JAK2/CALR/MPL, and pharmacogenomic NSCLC testing. Contact BCBSRI for specific updated InterQual criteria and ensure staff are trained on new requirements before submitting authorization requests.