CommercialAdministrativeHigh impact
Requirement to refer members to in-network providers for all BCBSRI products
Blue Cross Blue Shield of Rhode Island·RI·Provider Update
Effective date
Jul 1, 2021
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. Three specific laboratories (Total Toxicology, U.S. Lab & Radiology Inc., and Quest Diagnostics) are confirmed as out-of-network and cannot be used for BCBSRI member referrals.
Action Required
Immediately: All staff must verify provider network status using BCBSRI's Find a Doctor tool before making any referrals for BCBSRI members. Stop referring to Total Toxicology, U.S. Lab & Radiology Inc., and Quest Diagnostics for BCBSRI patients. Update referral workflows to include mandatory network verification step. Claims may be denied or members may face higher out-of-pocket costs for out-of-network referrals.