CommercialAdministrativeMedium impact
Beacon Health Options medical necessity criteria change
Blue Cross Blue Shield of Rhode Island·RI · Psychiatry·Behavioral Health
Effective date
Mar 1, 2020
We identified it
Jun 19, 2026
Summary
Beacon Health Options (BCBSRI's behavioral health vendor) is changing medical necessity criteria from their current standards to InterQual behavioral health criteria effective March 1, 2020. This change only affects utilization review for out-of-network behavioral health services, as in-network services remain exempt from prior authorization requirements.
Action Required
Before March 1, 2020: Billing team should update documentation processes for out-of-network behavioral health claims to align with InterQual criteria requirements. Review current out-of-network behavioral health billing practices and ensure medical necessity documentation meets the new InterQual standards. Contact Sarah Fleury at (401) 459-1384 with questions about specific criteria requirements.