Effective July 8, 2020 BCBSRI will resume prior authorization requirements for all products for the following: (unless COVID-19 related)

• Urgent and emergent inpatient level of care
• Long Term Acute Care
• Acute Inpatient Rehabilitation level of care
• Skilled Nursing Services

If you have any questions regarding these changes, please contact the Utilization Management team at 401-272-5670

Inpatient Stays:

Please continue to enter your admissions via the portal.

If COVID-19 related diagnosis, 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.

Prospect members please fax to 401-429-6377

Skilled Nursing, Acute Inpatient Rehabilitation and Long Term Acute Care:

It will be the responsibility of the hospital discharge planning department to obtain prior authorization for Skilled Nursing Facility, Acute Inpatient Rehabilitation facility and Long Term Acute Care (LTAC).

Elective procedures in a hospital setting will continue to require prior authorization.