Effective July 13th, eviCore will no longer allow authorizations to be entered into their authorizat...

 To offer best-in-class services related to utilization management (UM) functions, we are pleas...

Primary care providers (PCPs) accept responsibility for arranging and coordinating members’ overall ...

BCBSRI is actively pursuing National Committee for Quality Assurance (NCQA) Health Equity Accreditat...

BCBSRI is not a PPO network sharing plan. We are not allowed to price based on our participating pro...

As a reminder, DSNP member ID cards do not display copays or coinsurance. DSNP members can have cost...

The Centers for Medicare and Medicaid Services (CMS) reminds Medicare Advantage Organizations to con...

BCBSRI has seen an increase in claims processed by out-of-network providers or laboratories which we...

Effective July 1, 2026, Astrana Health will transition to a new Utilization Management system. ...

In July 2024, BCBSRI began performing additional prepayment claim reviews utilizing Optum’s Comprehe...

As a reminder, providers should be contacting Prime to obtain prior authorizations for in-scope...

, We are committed to ensuring the accuracy of the information in our Find a Doctor tool, the...

The latest Dual Special Needs Plan (D-SNP) Model of Care (MOC) evaluation and other performance resu...

We are aware of Anthem member claims denying with the explanation that the provider is contracted di...

To offer best-in-class services related to utilization management (UM) functions, we are pleased to ...

As a reminder, Astrana Health (formally Prospect) changed their telephone numbers on May 5, 2026. Ph...

Effective August 1, 2026, there will be updates to the following InterQual criteria subsets: CP...

Happy Pride Month! At BCBSRI, our mission is to advance health and well-being for all Rhode Islander...

To offer best-in-class services related to utilization management (UM) functions, we are pleased to ...

BCBSRI is committed to providing our members with access to high-quality healthcare that is consiste...

Effective May 1, 2026, Carelon will expand operations to seven days per week for our Medicare member...

Effective July 1, 2026, there will updates to the following InterQual Criteria subsets:   ...

, Astrana Health (formally Prospect) is changing their telephone numbers on May 5, 2026. Phon...

To offer best-in-class services related to utilization management (UM) functions, we are pleased to ...