CommercialPrior AuthMedium impact
MHK Updates
Blue Cross Blue Shield of Rhode Island·RI · Orthopedics, General Surgery, Oncology +2 more·Physician / Facility
Effective date
Jan 1, 2024
We identified it
Jun 19, 2026
Summary
BCBS Rhode Island is updating their MHK (Medical Home & Kidney) program effective January 1, 2024, with changes to InterQual subsets for lumbar spine procedures, bariatric surgery, and several molecular diagnostic tests including cancer and genetic testing protocols.
Action Required
By January 1, 2024: Review and update prior authorization workflows for lumbar decompression/fusion procedures and bariatric surgery cases. Clinical staff should verify updated InterQual criteria for molecular diagnostic testing including BCR::ABL1, CFTR, JAK2/CALR/MPL, and pharmacogenomic testing in lung cancer patients. Contact BCBS RI for specific updated criteria documentation.