May 1, 2024

Reminder: Medical Necessity Appeals (including Level of Care Appeals) - Contact Information Needed

In order to make the appeals process more efficient, please ensure you provide a valid name and phone number on your appeal requests for the person who will schedule peer-to-peer discussions. According to RI State regulations, BCBSRI will make two attempts to schedule a peer-to-peer for appeals denied for medical necessity. If our Grievances and Appeals Unit is unable to schedule the peer-to-peer, the appeal will be reviewed based on the clinical information available. 

We ask that you include the following information in your appeal request to ensure BCBSRI will be able to schedule the peer-to-peer with the Medical Director at BCBSRI.

  • Full name and valid phone number of the person who will be responsible for scheduling the peer-to-peer discussion.