CommercialPrior AuthHigh impact
November - December 2017
Blue Cross Blue Shield of Rhode Island·RI · Family Medicine, Internal Medicine, General Practice +1 more·Provider Update
Effective date
Jan 1, 2018
We identified it
Jun 20, 2026
Summary
Effective January 1, 2018, all BlueCHiP plans (Commercial and individual Medicare) will require primary care providers to generate web-based referrals to specialists before patients can see specialists. Claims for specialist services without proper web-based referrals will be denied.
Action Required
Before January 1, 2018: Primary care providers must begin using BCBSRI's web-based referral system for all BlueCHiP Commercial and individual BlueCHiP for Medicare specialist referrals. Billing team must verify referrals are in place before submitting specialist claims, as claims without web-based referrals will be denied. Note that referrals are valid for 180 days and can be generated retroactively within 30 days of specialist visit. Contact ProviderRelations@bcbsri.org for referral tool information.