BCBSRI welcomed The State of Rhode Island (identified with prefix of RIS and R2I) and Lifespan (identified as L7S) as new member groups as of January 1, 2020. We would like to remind providers of the information pertaining to prior authorization and referral requirements for these new memberships.

Prior authorization

For the State of Rhode Island (SORI) group and Lifespan, prior authorizations will be required per plan benefits for certain services. All BCBSRI prior authorization requirements should be verified prior to services being scheduled. All previous carrier authorizations were loaded into our system until January 31, 2020. For any date of services on or after February 1, 2020 that require an authorization, the provider will need to follow BCBSRI rules/procedures for obtaining the prior authorization. Additionally, Medical Drug Review (MDR) services should be verified for coverage prior to services being scheduled, as BCBSRI medical necessity requirements will apply even if MDR services were approved by the previous carrier. The previous carrier authorizations have been loaded directly into BCBSRI’s claims system. This one-time upload of the authorizations will not be visible on the Provider portal of bcbsri.com; however, you can call our Physician & Provider Service Center at (401) 274-4848 or 1-800-230-9050 (for out-of-state providers) who will be able to confirm the authorization we have on file for your patient.

As a reminder: SORI plans do not require an authorization for high-end radiology.

Referrals

The SORI Anchor plans have a copayment differential for specialist visits. If a referral is on file, the member will have a lower copayment. If no referral is on file, a higher copayment will be applied. The differential amount can be found on the member’s identification card or on the Provider portal of bcbsri.com. Health Trio, BCBSRI’s web-based referral tool, has been updated to include SORI membership data. In order to ease the transition of this large account, the lower copayment was automatically applied for dates of service in the month of January. Any services rendered on or after February 1, 2020, will apply the copay differential depending on if the member has a referral or not.

The Lifespan plans do not require a referral.