CommercialAdministrativeHigh impact
January 2017
Blue Cross Blue Shield of Rhode Island·RI·Provider Update
Effective date
Jan 1, 2017
We identified it
Jun 20, 2026
Summary
BCBSRI transitioned from OptumRx to Prime Therapeutics as their pharmacy benefits manager effective January 1, 2017, and implemented mandatory web-based referral management for all Commercial, BlueCHiP for Medicare Advance, and NEHP products. Prior authorizations transferred automatically with grace periods, but new PAs must be submitted through CoverMyMeds electronic system.
Action Required
Immediately: Update pharmacy prior authorization processes to use Prime Therapeutics instead of OptumRx. Register for CoverMyMeds electronic PA system at www.covermymeds.com. Primary care providers must use web-based referral management tool for all specialist referrals. Contact Prime at 1-855-457-0759 for Commercial or 1-800-693-6651 for Medicare PA assistance. Failure to submit referrals through web-based tool will result in claim denials.