Effective January 1, 2027, in partnership with eviCore, BCBSRI will expand eviCore’s authorization management to include physical and occupational therapy waiver program for our fully insured commercial population. eviCore will continue to manage all commercial appeals.

Notification will be required for physical and occupational therapy services for visits 1–14 per episode of care. Prior authorization will be required for physical therapy services and occupational therapy services beginning with the 15th visit per episode of care. Effective January 1, 2027, all physical and occupational therapy codes requiring authorization through eviCore will be outlined in the updated medical policy, “Prior Authorization of Physical and Occupational Therapy Services.”

As a reminder, all fully insured commercial plans have different benefit limits. Please ensure you are reviewing the member’s limits on the provider portal. If you need assistance on where to find the limit, please contact ProviderRelations@bcbsri.org.

eviCore will hold two educational webinars in December. Participants will learn how to obtain authorizations through the eviCore website and authorization timeframes.

To register for one of the webinars, please visit the eviCore webinar registration page.

After you have registered, you will receive an email containing the toll-free phone number, meeting number, conference password, and a link to the web portion of the session. Please retain the registration email so you will have the link to the web conference and the call-in number for the session in which you will be participating.

If you have any questions regarding the eviCore web portal, please contact the Web Support team at portal.support@evicore.com or 1-800-646-0418 (Option 2). For any provider inquiries not associated with this training, please email ClientServices@evicore.com.

If you have any additional questions about these changes, please contact Provider Relations at 1-844-707-5627 or ProviderRelations@bcbsri.org.