BCBSRI is taking an additional step to support its members during the COVID-19 crisis.

• Effective for dates of service on December 1, 2020 through December 31, 2020 BCBSRI will be suspending 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 be suspending 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 section of BCBSRI’s website.  

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 to 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.

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. 

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 extension 3364 for any questions.

Prospect members please fax to 401-429-6377.