BCBSRI’s behavioral health vendor, Beacon Health Options, Inc. (Beacon), is changing the medical necessity criteria for behavioral health services effective 1 de março, 2020. At that time Beacon will utilize InterQual behavioral health criteria when conducting utilization review for behavioral health services.

Beacon will continue to use other state-mandated criteria where directed to do so including American Society for Addiction Medicine (ASAM) level of care criteria for medical necessity reviews for substance use disorder services.

This change does not impact BCBSRI’s current policy related to utilization review for behavioral health services. BCBSRI is maintaining its policy of not applying approval or authorization requirements (utilization review) to in-network behavioral health services and is continuing to apply the notification of admission and discharge process that has been in place since 1 de agosto, 2018. This criteria change will apply to utilization review for out-of-network services.

If you have any questions or concerns about this change, please contact Sarah Fleury, manager of behavioral health, at (401) 459-1384.