This is a reminder to all specialists regarding the requirements for reducing Prior Authorization requests. It has come to our attention, through feedback from numerous PCP practices, that specialists are continuing to submit Prior Authorization requests to PCP offices when an authorization is not required and are not utilizing the Prior Authorization tool available on the provider portal.

Specialists are responsible for determining whether a service requires prior authorization. Please ensure you use the designated tools to verify authorization requirements before submitting any requests to the member’s PCP office.

As of May last year, we implemented a list of 62 codes that no longer require prior authorization across all lines of business. This list has since been updated to 53 codes, as nine codes have been removed and no longer require prior authorization for any line of business.

Later in the year on October 1, 2025, we announced prior authorization will not be required for fully insured Commercial members for any service.

PCP offices are not responsible for determining whether prior authorization is necessary. We strongly encourage you to utilize the available tools to make this determination.

• Use the Prior Authorization tool to verify whether the ordering provider is a PCP and if the code is included on the waiver list.
• Check the member’s product information on bcbsri.com or within your EHR system to confirm the member’s eligibility and funding via the 270/271 file.

If your office has questions or needs additional information or training regarding this process, please contact ProviderRelations@bcbsri.org.