CommercialPrior AuthHigh impact
BCBSRI will resume prior authorization for all products effective June 11, 2021 with the exception if member’s primary diagnosis is COVID-19
Blue Cross Blue Shield of Rhode Island·RI·Physician / Facility
Effective date
Jun 11, 2021
We identified it
Jun 19, 2026
Summary
BCBSRI is resuming prior authorization requirements for all products effective June 11, 2021, with exceptions for COVID-19 primary diagnosis cases. For COVID-19 cases, notification requirements within 48 hours still apply for inpatient stays, rehabilitation, and skilled nursing facilities.
Action Required
By June 11, 2021: Billing team must reinstate prior authorization workflows for all BCBSRI products except COVID-19 primary diagnosis cases. Update billing system to flag BCBSRI services requiring prior auth. For COVID-19 cases: notify admissions/discharges within 48 hours via portal (401) 272-5670, fax to (401) 272-8885 for general cases or (401) 429-6377 for Prospect members. SNF must notify by day 3 to (401) 459-1623. Failure to obtain prior auth or proper notification will result in claim denials.