On August 1, 2018, BCBSRI changed its process to no longer require utilization review (prior approval or continued stay reviews) for inpatient and intermediate levels of in-network behavioral health services. This policy change applies to all Commercial and Medicare Advantage products, with the exception of the Federal Employee Program (FEP).

In place of a utilization review, admitting providers are required to submit a notification of admission and discharge for inpatient and intermediary levels of treatment occurring in-network. This required process of notification replaces the need for a utilization review.

If a provider submits a claim without notifying Beacon Health Options of an admission the claim will be denied. If the provider has not updated their authorization to have the correct number of units, the claim will be processed against the number of units that were provided to Beacon. In both instances, providers must contact BCBSRI for an administrative appeal.