BCBSRI is taking the following additional steps to support its members during the COVID-19 pandemic:

• Effective until April 30, 2021 or when the public health emergency is lifted (whichever happens first), BCBSRI will continue to suspend prior authorization requirements for Medicare Advantage products for the following:
  • Urgent and emergent inpatient level of care
  • Long-term acute care
  • Acute inpatient rehabilitation level of care
  • Skilled nursing services
• Effective for dates of service on December 1, 2020 and until further notice, BCBSRI will suspend prior authorization requirements for all other products (including New England Health Plan members with a RI PCP), with the exception of Federal Employee Program (FEP), for the following:
  • Urgent and emergent inpatient level of care (FEP only if COVID-19 related)
  • Long-term acute care
  • Acute inpatient rehabilitation level of care
  • Skilled nursing services

BCBSRI reserves the right to implement and revoke this temporary waiver without the contractual sixty-day (60) notification for a change that is normally required under BCBSRI contracts with its providers. Notice of the implementation, update, or withdrawal of this temporary waiver will be communicated to BCBSRI providers via a notice on BCBSRI’s provider website/portal under “Alerts and Updates” as well as within the “Policies and Coverage, Preauthorization” section of the Provider page of bcbsri.com.

There are still requirements for each service as noted below. If you have any questions regarding these changes, please contact the utilization management team at (401) 272-5670.

Inpatient stays

We continue to require notification of admission and discharge so an authorization record can be entered into our system to ensure reimbursement of your claim. Please continue to enter your admissions via the portal as we will use that as a form of notification within 48 hours of admission. BCBSRI will require a notice of discharge within 48 hours of the discharge. It will be the responsibility of the accepting skilled nursing facility, acute inpatient rehabilitation facility, and long-term acute care (LTAC) to notify BCBSRI of admission. Elective procedures in a hospital setting will continue to require prior authorization.

For Prospect members, please fax to (401) 429-6377.

Acute inpatient rehabilitation

We continue to require notification of admission and discharge so an authorization record can be entered into our system to ensure reimbursement to your claim. Please contact the utilization management team within 48 hours of admission and 48 hours of discharge at (401) 272-5670 or fax your notification to (401) 272-8885.

For Prospect members, please fax to (401) 429-6377.

Skilled nursing facility

You will be responsible to notify the utilization management team of an admission prior to day three of admission. Please fax notification of admission and supporting clinical information to (401) 459-1623 at that time. BCBSRI will continue to require concurrent stay reviews on all members. You may contact the SNF utilization management team at (401) 459-1000, ext. 3364 with any questions.

For Prospect members, please fax to (401) 429-6377.