CommercialAdministrativeHigh impact
Requirement to refer members to in-network providers
Blue Cross Blue Shield of Rhode Island·RI·Physician / Behavioral Health
Effective date
Nov 1, 2022
We identified it
Jun 19, 2026
Summary
BCBSRI now requires all contracted providers to refer members exclusively to in-network providers for all services including durable medical equipment, radiology, behavioral health, and laboratory services. Several specific laboratories are identified as out-of-network and should not be used for referrals.
Action Required
Immediately: All providers must verify network status before making referrals using BCBSRI's Find a Doctor tool. Stop referring to Accu Reference Lab, Quest Diagnostics, Total Toxicology, and U.S. Lab & Radiology, Inc. Update referral workflows to include network verification step for all services including DME, radiology, behavioral health, and laboratory services. Train staff on network verification requirements to avoid out-of-network claims.