BCBSRI will resume prior authorization for all products effective 11 de junho, 2021 with the exception if member’s primary diagnosis is COVID-19 for the following:

• urgent and emergent inpatient level of care
• long-term acute care
• acute inpatient rehabilitation level of care
• skilled nursing services

There are still requirements for each service if primary diagnosis is COVID-19 as noted below. If you have any questions regarding these changes, please contact the Utilization Management team at (401) 272-5670.

Inpatient Stays:

We continue to require notification of admission and discharge if primary diagnosis is COVID-19 so an authorization record can be entered into our system to ensure reimbursement of your claim. Please continue to enter your admissions via the portal as we will use that as a form of notification within 48 hours of admission. BCBSRI will require a notice of discharge within 48 hours of the discharge. It will be the responsibility of the accepting skilled nursing facility, acute inpatient rehabilitation facility, and long-term acute care (LTAC) to notify BCBSRI of admission. Elective procedures in a hospital setting will continue to require prior authorization.

Prospect members please fax to (401) 429-6377.

Acute Inpatient Rehabilitation:

We continue to require notification of admission and discharge if primary diagnosis is COVID-19 so an authorization record can be entered into our system to ensure reimbursement of your claim. Please contact the Utilization Management team within 48 hours of admission and 48 hours of discharge at (401) 272-5670 or fax your notification to (401) 272-8885. 

Prospect members please fax to (401) 429-6377.

Skilled Nursing Facility:

You will be responsible to notify the Utilization Management team of an admission if primary diagnosis is COVID-19 prior to day three of admission. Please fax notification of admission and supporting clinical information to (401) 459-1623 at that time. BCBSRI will continue to require concurrent stay reviews on all members. You may contact the SNF Utilization Management team at (401) 459-1000 ext. 3364 for any questions.

Prospect members please fax to (401) 429-6377.