CommercialAdministrativeMedium impact
BCBSRI notification of admission process
Blue Cross Blue Shield of Rhode Island·RI · Psychiatry·Behavioral Health
Effective date
Jul 1, 2023
We identified it
Jun 19, 2026
Summary
BCBSRI now requires facilities to notify them within 48 hours of admission to or discharge from behavioral health services, but no prior authorization is needed for most services. Medical necessity reviews are still required for specific high-level services like inpatient mental health, residential treatment, ABA, and TMS.
Action Required
Immediately: Billing and admissions staff must establish process to notify BCBSRI behavioral health within 48 hours of any member admission to or discharge from covered behavioral health levels of care (inpatient mental health, detox/rehab, crisis stabilization, residential treatment, partial hospitalization, intensive outpatient, CFIT, ABA, TMS). Continue obtaining medical necessity reviews for inpatient mental health, inpatient withdrawal management, residential treatment, ABA, and TMS services. Note: FEP members are exempt from notification requirement.