Medicare AdvantagePrior AuthHigh impact
January 2018
Blue Cross Blue Shield of Rhode Island·RI·Provider Update
Effective date
Jan 1, 2018
We identified it
Jun 20, 2026
Summary
BCBS Rhode Island now requires PCP-generated web-based referrals for ALL individual Medicare Advantage plans effective January 1, 2018 (previously only required for Advance members). Specialist claims will be denied without proper referrals, and retroactive referrals are allowed within 30 days.
Action Required
Immediately: All PCPs must generate web-based referrals for individual BlueCHiP Medicare Advantage specialist visits before services are rendered. Specialists must verify referral exists before providing services. Claims without referrals will be denied and specialists held liable. Update workflows to check referral status and generate retroactive referrals within 30 days if needed. Note: Group Medicare Advantage and behavioral health services are exempt.