BCBSRI is excited to welcome two new large employer accounts as of January 1, 2020: The State or Rhode Island (identified with prefix of RIS and R2I) and Lifespan (identified with prefix of L7S). We would like to share information on prior authorization and referral requirements for this new membership.

Prior Authorization

For the Lifespan Employer Group and the State of Rhode Island, prior authorizations will be required per plan benefits. All BCBSRI prior authorization requirements should be verified prior to services being scheduled. 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. BCBSRI is currently working with the previous carrier to load all prior authorizations on file for services that would be covered by BCBSRI as of the middle of December for dates of service 1/1/2020 and after. The previous carrier authorizations will be loaded directly into BCBSRI’s claims system as of mid-December. Inpatient and MDR services will be loaded for the timeframe the previous carrier approved outpatient services and procedures will be loaded as approved up to 1/31/20. This onetime 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. 

Referrals

The State of Rhode Island (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, will be updated to include the SORI membership data around the middle of December to allow you to begin entering referrals for dates of service 1/1/2020 and after. In order to ease the transition of this large account the lower copayment will automatically be applied for dates of service during the month of January. We encourage providers to enter all referrals in accordance with the plan requirements to avoid member disruption going forward.

The Lifespan Employer Group product does not have a referral requirement.