BCBSRI continually works to streamline the prior authorization process so we can enhance our member and provider experience. Please ensure that you are up to date with how to get your authorization processed quickly and auto-approved where possible by following the tips below.
“Facility provider” is not a required field for outpatient service requests
For facilities entering outpatient service request prior authorizations through the MHK web portal, please note “Facility Provider” is not a required field. Most facilities should enter themselves as the requesting provider and include only the servicing provider on their authorizations. Do not enter a facility provider on service requests as it is not required and may cause a delay in processing if entered incorrectly. The facility provider is still required for providers submitting inpatient requests.
Reminder: Please attend a provider portal training session
BCBSRI has dedicated resources to providing additional educational training sessions and we encourage all network providers to take advantage of this opportunity. These sessions are typically 30-60 minutes long and will consist of a demo of the authorization process and trained staff to answer all your questions. This is your opportunity to speak directly to our UM manager, MHK system administrators, and a provider relations representative.
Providers who have been continuously submitting incorrect authorizations received an e-mail from BCBSRI informing them they’re required to attend a provider portal retraining. Please arrange a date with BCBSRI at your earliest convenience. You may either attend a scheduled group training or arrange an individual provider training. We encourage everyone in your office who enters authorizations to attend.
Please know that if you have received an e-mail and do not attend a required training, your BCBSRI.com account will be deactivated. You will no longer be able to submit prior authorizations through our portal and your account cannot be reactivated by the provider customer service team without first attending a training session.
Why do I need to choose a “Par” provider status?
As many provider offices now know, when searching for a requesting/servicing/facility provider, you should always select the “Par” provider status when available. BCBSRI makes every effort to streamline your authorization process and auto-approve as many authorizations as we can. This way your office can focus on providing care for members instead of being concerned with prior authorization. Many of our authorizations will only be auto-approved when a provider with a status of “Par” is selected. If your provider is participating with our member’s plan, always select the “Par” option.
BCBSRI.com account sharing
It has come to our attention some provider offices are sharing a single BCBSRI.com account to submit prior authorizations. Do not share bcbsri.com accounts to submit authorizations as this is against our policy. Please work with your administrator and provider relations to set up separate accounts.
Viewing authorizations in the provider portal
All your authorization details and history can be viewed in the MHK provider portal by expanding the drop-down and selecting “View Authorizations” on the left-hand side of the prior authorization input screen. This feature will show any open authorizations and a history of previously approved authorizations. Providers can perform various actions from this screen like viewing authorization details, uploading attachments, and searching for authorizations by member ID and other information. You may also print authorization details by selecting the authorization number and selecting print. We encourage providers to use this as a first resource for authorization information prior to calling.
