Prior Authorization of Services, Treatments or Procedures
Defines BCBSRI prior authorization requirements and process for certain medical procedures using the insurer's online prior authorization tool; affects participating and non‑participating providers and applies to Medicare Advantage and Commercial products.
Effective 10/1/2025, for Fully-Funded Commercial Products only, prior authorization requests may not be needed when the requesting physician is a BCBSRI Contracted Primary Care Provider for listed specialties.
Effective 5/15/2025, prior authorization requests for certain services may not be needed when the requesting physician is a BCBSRI Contracted Primary Care Provider; see attached code grid for applicable services.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.