Prior Authorization via Web-Based Tool for Procedures
This draft policy governs prior authorization requests for certain medical procedures using the BCBSRI online prior authorization tool and explains when authorization is required or exempt, affecting participating providers and Medicare Advantage and Commercial plan members.
Effective 5/15/2025, authorization requests for certain services may not be needed when the requesting physician is a BCBSRI Contracted Primary Care Provider.
Prior authorization is required for Medicare Advantage Plans and recommended for Commercial Products, with certain PCP specialties exempted from authorization requirements.
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