As communicated in the past few months, effective October 1, 2025, providers who are credentialed as an eligible PCP no longer need to submit prior authorization requests for any admission, item, service, treatment, or procedure, except medications, for fully insured members only. This change is expected to simplify workflows, reduce delays in patient care, and improve overall provider satisfaction.

Utilizing the eligibility portion of the web your office uses today, you will continue to check the member’s BCBSRI ID. By entering the member’s BCBSRI ID, you will know if the member is fully insured commercial member. 

If you need a personalized training on the new process, please contact ProviderRelations@bcbsri.org.