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
May 1, 2019
We identified it
Jun 20, 2026
Summary
BCBSRI-contracted providers must now coordinate all member care through in-network providers only, including laboratory, radiology, pathology, durable medical equipment, and specialty services. The policy specifically lists four laboratories that are NOT participating providers and should not be used for referrals.
Action Required
Immediately: All providers and billing staff must verify network participation status before establishing any referral relationships. Use BCBSRI's Find a Doctor tool to confirm provider participation for each patient's specific plan (e.g., BlueCHiP Advance). Stop referring to non-participating labs: Mercy Diagnostics, Total Toxicology, U.S. Lab & Radiology Inc., and Quest. Update referral protocols and train staff on network verification requirements.