Effective January 1, 2024, notification and prior authorization will no longer be required for home health services for all products. As of January 1, 2024, home care agencies will no longer have to use the MHK provider portal to submit requests. Any retrospective home healthcare delivered prior to January 1, 2024 can be faxed into BCBSRI’s utilization management team at (401) 459-1623 or to Prospect’s utilization management team at 1-844-762-9230.

If your agency has any authorization inquiries, please contact BCBSRI’s utilization management team at (401) 272-5670, option 4 or Prospect’s utilization management team at 1-844-762-9231.

January 1, 2024 updates PBF

• Mental health counselors and marriage and family therapists will be allowed to render services to Medicare members. 
• All Medicare Advantage Plans, BlueCHiP Direct, BlueCHiP Direct Advance, BlueCHiP w/ Flex, Network Blue New England, Network Blue New England Options and Blue Choice New England products will not require a referral for Physical and Occupational Services.
• Our Access product will now be open to Prospect PCPs. 
• EyeMed – Hardware claims:
  • If a provider is participating with EyeMed, they will file the member’s hardware claim to EyeMed for reimbursement. 
  • If a provider is not participating with Eye Med, the member will need to file their hardware claim to EyeMed for reimbursement.