Blue Cross & Blue Shield of Rhode Island to end nearly 65% of prior authorization requirements

Move aims to expedite care for patients and relieve administrative burden on primary care practices 

Blue Cross & Blue Shield of Rhode Island (BCBSRI) has announced it will soon be eliminating nearly 65% of prior authorization requirements for primary care providers (PCPs) by early 2025. This is consistent with BCBSRI’s removal of all prior authorization for outpatient behavioral healthcare since 2018.

Prior authorization, which requires doctors to obtain approval from health insurers before providing certain medical services, helps ensure that patients are receiving appropriate, safe, and cost-effective care. It can also promote new standards of care and reduce avoidable care.

But prior authorization has been cited nationally as contributing to unnecessary delays, inefficiencies, and frustrations for both providers and patients. 

BCBSRI, responding to these concerns and local efforts to bolster primary care, engaged in discussions with state regulators, members of the General Assembly, and health system stakeholders. This new initiative will substantially scale back prior authorization requirements for medical services ordered by primary care providers, who are foundational to an effective healthcare system.

“We recognize that prior authorization can be a significant source of additional administrative burden and stress for primary care providers at a time when PCPs are struggling,” said Martha L. Wofford, president and CEO of BCBSRI. “We’re hopeful that reducing these authorizations, along with our significant investments in primary care practices, will help PCPs thrive and improve patient access to care as we continue to strive for balance between affordability for Rhode Islanders and stability for providers.” 

BCBSRI took a data-driven approach to identify some of the most common orders that create additional work for PCPs. The review will result in the lifting of prior authorization requirements for numerous medical services, with radiology and cardiology leading the list. The reduction in prior authorization will benefit providers and patients in both commercial and Medicare plans. 

BCBSRI’s initiative aligns with the work of the Rhode Island Office of the Health Insurance Commissioner (OHIC), which issued a report on primary care last December. Among its findings were that clinician burnout is a ‘key concern” for the workforce and that prior authorization can “exacerbate burnout.” The report called on insurers to “make significant reductions in the administrative burden” placed on PCPs.  

BCBSRI says it is committed to improving access to high quality, affordable and equitable care for all Rhode Islanders and promoting a stable healthcare system in Rhode Island. Efforts to streamline prior authorization will continue in partnership with healthcare leaders across the state and details of the current initiative will be shared with BCBSRI’s network of PCPs and members in the coming months. 

About BCBSRI 

Blue Cross & Blue Shield of Rhode Island (bcbsri.com) is a non-profit, community-focused health plan established in 1939 to help Rhode Islanders finance their healthcare needs. Today, that purpose is still foundational to our work. We have a vision to improve health and well-being by leading access to high quality, affordable, and equitable care. We are an independent licensee of the Blue Cross and Blue Shield Association. Connect with us on Facebook, LinkedIn and Instagram. Listen to BCBSRI’s podcast, The Rhode to Health, on BuzzSprout, Apple Podcasts, and Spotify.