CommercialPrior AuthHigh impact
Referrals for the BlueCHiP Direct Advance plan
Blue Cross Blue Shield of Rhode Island·RI·Physician / Facility
Effective date
Sep 1, 2021
We identified it
Jun 19, 2026
Summary
BlueCHiP Direct Advance plan requires PCPs to generate all specialist referrals - specialists cannot create their own referrals. Claims for specialist services will be denied without proper PCP referral.
Action Required
Immediately: Billing team must verify PCP referral exists before scheduling any specialist appointments for BlueCHiP Direct Advance members (ID cards with prefix ZBE). Use BCBSRI web-based referral tool to verify referral status before rendering services. Front desk staff must check member eligibility on bcbsri.com portal prior to appointments. Failure to have proper referral will result in claim denials.