BCBSRI is excited to welcome two new large employer accounts as of January 1, 2020: The State of Rhode Island (identified with prefix of RIS and R2I) and Lifespan (identified with prefix of L7S). We would like to share information on prior authorization and referral requirements for this new membership.

Prior authorization

For Lifespan and the State of Rhode Island, prior authorizations will be required per plan benefits. All BCBSRI prior authorization requirements should be verified prior to services being scheduled. Additionally, medical drug review (MDR) services should be verified for coverage prior to services being scheduled, as BCBSRI’s medical necessity requirements will apply even if MDR services were approved by the previous carrier. BCBSRI worked with the previous carrier to load all prior authorizations on file for services that would be covered by BCBSRI as of the middle of December, for dates of service January 1, 2020 and after. The previous carrier’s authorizations will be loaded directly into BCBSRI’s claims system as of mid-December. Inpatient and MDR services will be loaded for the timeframe the previous carrier approved outpatient services, and procedures will be loaded as approved up to January 31, 2020. This one-time upload of the authorizations will not be visible on the provider portal of bcbsri.com; however, you can call our Physician & Provider Service Center at (401) 274-4848 or 1-800-230-9050 (for out-of-state providers) who will be able to confirm the authorization we have on file for your patients.

Referrals

The State of Rhode Island (SORI) Anchor plans have a copayment differential for specialist visits. If a referral is on file, the member will have a lower copayment. If no referral is on file a higher copayment will be applied. The differential amount can be found on the member’s identification card or on the provider portal of bcbsri.com. Health Trio, BCBSRI’s web-based referral tool, was updated to include the SORI membership data around the middle of December to allow you to begin entering referrals for dates of service January 1, 2020 and after. In order to ease the transition of this large account, the lower copayment will automatically be applied for dates of service during the month of January. We encourage providers to enter all referrals in accordance with the plan requirements to avoid member disruption going forward.

The Lifespan employer group product does not have a referral requirement.