Blue Cross Blue Shield - Rhode Island Prior Authorization Lookup
- Blue Cross Blue Shield - Rhode Island timely filing
- Blue Cross Blue Shield - Rhode Island coverage criteria
- All Blue Cross Blue Shield - Rhode Island policy updates
Latest Blue Cross Blue Shield - Rhode Island prior authorization updates25
- Prior AuthClinical/Medical PolicyEff. 2026-10-01Epidural Steroid Injections (ESIs) for Pain ManagementCommercial product coverage criteria and coding guidance for epidural steroid injections (interlaminar and transforaminal; cervical, thoracic, lumbar/sacral) when medical criteria in the payer's online authorization tool are met. Applies to participating providers submitting prior authorization for commercial members; Medicare Advantage has a separate policy.All Blue Cross Blue Shield - Rhode Island updates
- Prior AuthClinical/Medical PolicyEff. 2026-10-01New Technology and Miscellaneous Services (Category III CPT® Codes)Defines BCBSRI coverage categories and prior authorization rules for CPT codes representing new and emerging technologies (primarily Category III codes) for Medicare Advantage and Commercial products.All Blue Cross Blue Shield - Rhode Island updates
- Prior AuthReimbursement/Payment PolicyEff. 2026-10-01Prior Authorization for Durable Medical Equipment (DME)Defines prior authorization requirements and medical necessity criteria for durable medical equipment (DME) for Blue Cross Blue Shield - Rhode Island members, affecting participating providers and other requestors submitting authorization requests.All Blue Cross Blue Shield - Rhode Island updates
- Prior AuthClinical/Medical PolicyEff. 2026-10-01Prior Authorization of Services, Treatments or ProceduresThis draft policy governs BCBSRI's prior authorization request process for certain medical procedures using the BCBSRI online prior authorization tool and specifies when prior authorization is required or exempted for providers and plan types.All Blue Cross Blue Shield - Rhode Island updates
- Prior AuthClinical/Medical PolicyEff. 2026-10-01View PDF of Maternal Serum Biomarkers for Prediction of Adverse Obstetric Outcomes, Effective 10/1/2026 in MedicalDefines Blue Cross Blue Shield - Rhode Island's coverage stance for specific maternal serum biomarker tests (PlGF Preeclampsia Screen CPT 0243U; PreTRM CPT 0247U; PreClara sFlt-1/PlGF CPT 0524U) for prediction of preeclampsia and spontaneous preterm birth for Medicare Advantage and Commercial Products, including prior authorization and laboratory participation rules.All Blue Cross Blue Shield - Rhode Island updates
- Prior AuthClinical/Medical PolicyEff. 2026-09-01Balloon Dilation of the Eustachian TubeThis draft policy governs medical necessity, prior authorization, coverage, and coding for balloon dilation of the eustachian tube (BDET) for Medicare Advantage and Commercial members, including adult and pediatric criteria.All Blue Cross Blue Shield - Rhode Island updates
- Prior AuthClinical/Medical PolicyEff. 2026-09-01Biomarker and Genetic/Molecular Testing Coverage and Prior AuthorizationGoverns coverage, medical necessity, and prior authorization requirements for biomarker and genetic/molecular testing for BCBSRI Commercial Products and Medicare Advantage Plans in accordance with the Rhode Island biomarker testing mandate. Affects ordering providers, laboratories, and covered members.All Blue Cross Blue Shield - Rhode Island updates
- Prior AuthClinical/Medical PolicyEff. 2026-09-01Multimarker Serum Testing Related to Ovarian CancerPolicy governs coverage and prior authorization for FDA-cleared multimarker serum tests (OVA1, Overa, ROMA) used to assess malignancy risk in women with ovarian adnexal masses for Blue Cross Blue Shield - Rhode Island members.All Blue Cross Blue Shield - Rhode Island updates
- Prior AuthClinical/Medical PolicyEff. 2026-09-01Prior Authorization of Services, Treatments or ProceduresDefines BCBSRI's prior authorization requirements and process for certain medical procedures, including which providers and products require authorization and how requests should be submitted.All Blue Cross Blue Shield - Rhode Island updates
- Prior AuthClinical/Medical PolicyEff. 2026-09-01Prior Authorization of Services, Treatments or ProceduresDefines BCBSRI's prior authorization request process (online tool and fax alternative) for certain medical procedures and which provider types/situations require or are exempt from prior authorization. Affects providers requesting authorization for Medicare Advantage and Commercial products.All Blue Cross Blue Shield - Rhode Island updates
- Prior AuthClinical/Medical PolicyEff. 2026-09-01Prior Authorization of Services, Treatments or Procedures, Effective 9/1/2026All Blue Cross Blue Shield - Rhode Island updates
- Prior AuthClinical/Medical PolicyEff. 2026-09-01Prior Authorization of Spinal ProceduresDefines when prior authorization is required or recommended for spinal procedures for BCBSRI members, and identifies which product lines and provider types are affected.All Blue Cross Blue Shield - Rhode Island updates
- Prior AuthClinical/Medical PolicyEff. 2026-09-01Whole Exome and Whole Genome Sequencing for Diagnosis of Genetic DisordersDefines medical necessity, prior authorization, and coverage criteria for whole exome sequencing (WES) and whole genome sequencing (WGS), including rapid testing and specific proprietary Genomic Unity® Exome Plus analyses, for Medicare Advantage and Commercial products of BCBSRI.All Blue Cross Blue Shield - Rhode Island updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-01Biomarker Testing / Genetic & Molecular Testing Coverage CriteriaGoverns state-mandated coverage, medical necessity, and prior authorization requirements for biomarker and genetic/molecular tests for BCBSRI Commercial Products and Medicare Advantage Plans.All Blue Cross Blue Shield - Rhode Island updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-01InVisionFirst (Inivata, Inc.) circulating tumor DNA (ctDNA) test coverage and prior authorizationPolicy governs coverage and prior authorization requirements for the InVisionFirst (Inivata, Inc.) ctDNA test (CPT 0388U) for Medicare Advantage and Commercial members of Blue Cross & Blue Shield of Rhode Island.All Blue Cross Blue Shield - Rhode Island updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-01New Technology and Miscellaneous ServicesDefines BCBSRI coverage determinations and administrative expectations for CPT codes representing new and emerging technologies (primarily Category III codes) for Medicare Advantage and Commercial products; affects providers submitting claims and prior authorization requests to Blue Cross Blue Shield of Rhode Island.All Blue Cross Blue Shield - Rhode Island updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-01Biomarker Testing MandateDefines medical necessity, coverage, and prior authorization requirements for biomarker testing for Blue Cross Blue Shield - Rhode Island, addressing Commercial Products and Medicare Advantage Plans and implementation of a state-mandated biomarker testing coverage statute.All Blue Cross Blue Shield - Rhode Island updates
- Prior AuthReimbursement/Payment PolicyEff. 2026-07-01New Technology and CPT Codes for Medicare Advantage and Commercial ProductsDefines BCBSRI coverage categories and practices for Current Procedural Terminology (CPT) codes representing new and emerging technologies, and explains prior authorization applicability for Medicare Advantage and Commercial products.All Blue Cross Blue Shield - Rhode Island updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-01New Technology and Miscellaneous Services (Category III CPT® and related codes)Defines coverage determinations for CPT codes representing new and emerging technologies (primarily Category III codes) for BCBSRI Medicare Advantage and Commercial products; affects providers submitting claims and seeking prior authorization for these services.All Blue Cross Blue Shield - Rhode Island updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-01Next Generation Sequencing for Solid TumorsPolicy governing medical necessity and prior authorization for specified next generation sequencing tissue tests for solid tumors for Medicare Advantage and Commercial products of Blue Cross Blue Shield - Rhode Island.All Blue Cross Blue Shield - Rhode Island updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-01Open and Thoracoscopic Approaches to Treat Atrial Fibrillation and Atrial Flutter (Maze and Related Procedures)Defines medical necessity, coverage stance, and prior authorization requirements for open and thoracoscopic maze and related procedures to treat symptomatic atrial fibrillation or atrial flutter for Medicare Advantage and Commercial products.All Blue Cross Blue Shield - Rhode Island updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-01Orthognathic SurgeryThis policy governs prior authorization, coding, and medical necessity determinations for orthognathic (maxillary and mandibular) surgical procedures for Medicare Advantage Plans and Commercial Products of Blue Cross Blue Shield - Rhode Island.All Blue Cross Blue Shield - Rhode Island updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-01Orthognathic SurgeryThis policy governs medical necessity and prior authorization for orthognathic (maxilla/mandible) surgical procedures for Medicare Advantage and Commercial products of Blue Cross Blue Shield - Rhode Island.All Blue Cross Blue Shield - Rhode Island updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-01Percutaneous and Subcutaneous Tibial Nerve StimulationThis policy defines medical necessity, coding, and prior authorization expectations for percutaneous tibial nerve stimulation (PTNS) and subcutaneous/implantable tibial nerve stimulation for treatment of voiding dysfunction and overactive bladder for BCBSRI Medicare Advantage and Commercial products.All Blue Cross Blue Shield - Rhode Island updates
- Prior AuthReimbursement/Payment PolicyEff. 2026-07-01Prior Authorization for Durable Medical Equipment (DME)This policy governs prior authorization requirements and the use of medical necessity criteria for durable medical equipment for Blue Cross Blue Shield - Rhode Island members, affecting providers requesting DME for Medicare Advantage and Commercial products.All Blue Cross Blue Shield - Rhode Island updates
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Tool Description
Search Blue Cross Blue Shield - Rhode Islandprior authorization policies by drug name, procedure, or policy title. Results include any policy that mentions prior authorization requirements (drug coverage criteria, imaging guidelines, site-of-service rules) not just documents titled “prior authorization.” Every result links to a full policy page with clinical criteria, covered billing codes, documentation requirements, and effective dates.
Filter by payer, specialty, policy type, or effective year; or search directly for a drug (“Wegovy,” “Ozempic”), a procedure (“MRI,” “knee arthroplasty”), or a policy number.
Coverage spans 110+ payers. Jump straight to the busiest prior-auth publishers: UnitedHealthcare, Cigna, Aetna, Anthem, and Centene. You can also browse the full policy updates feed.
Pair a prior-auth search with the billing code lookup to confirm the CPT or J-code on the claim, the payer lookup for plan footprint, and payer profiles for contacts and coverage context.
FAQ
Type a drug name (“Wegovy,” “Ozempic”), a procedure (“MRI,” “knee”), or a policy title into the search bar. Filter results by payer, specialty, policy type, or effective year. Open any result for the full policy page with clinical criteria, covered billing codes, documentation requirements, and effective dates.
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