CommercialAdministrativeHigh impact
Requirement to refer members to in-network providers
Blue Cross Blue Shield of Rhode Island·RI·Provider Update
Effective date
Dec 1, 2022
We identified it
Jun 19, 2026
Summary
BCBSRI now requires contracted providers to refer members only to in-network providers for all services including DME, radiology, behavioral health, and lab services. Five specific laboratories are confirmed as out-of-network and should not be used for BCBSRI member referrals.
Action Required
Immediately: All providers must verify network status before establishing referrals using BCBSRI's Find a Doctor tool. Stop referring BCBSRI members to Accu Reference Lab, Quest Diagnostics, Total Toxicology, and U.S. Lab & Radiology. Update referral workflows to include network verification step for DME, radiology, behavioral health, and laboratory services. Claims may be denied or subject to out-of-network penalties if members are referred to non-contracted providers.