BCBSRI's November 1 provider notices and accompanying proposed 2027 therapy policy
Blue Cross & Blue Shield of Rhode Island will expand eviCore's therapy authorization program to fully insured commercial members in 2027. Its November 1 announcement sets a two-stage process for OT and PT: notification for visits 1–14 per episode of care, then prior authorization beginning with visit 15.
In brief
- The commercial change takes effect at plan renewal on or after January 1, 2027.
- Notification is required during the first 14 visits; further visits need authorization.
- Member benefit limits and the applicable policy exceptions still need checking.
The renewal date belongs in the chart
The insurer's companion medical-policy notice adds a qualification to the January start: the commercial requirement applies upon renewal on or after January 1. That detail gives clinics a reason to record the member's renewal date alongside the therapy episode and visit count. A calendar-year reminder alone could leave staff applying the new process at the wrong point in a patient's plan year.
The announcement identifies fully insured commercial coverage. Staff should verify the patient's actual product before changing the workflow. A familiar insurer name on an identification card is only the beginning of that check.
Fourteen visits still require notification
BCBSRI requires notification for the first 14 visits per episode. The accompanying proposed policy text includes the initial assessment or evaluation in that requirement. It also lists telehealth, home health and inpatient therapy as exceptions to notification and authorization. Clinics should check the issued policy and applicable code guidance before relying on an exception.
Benefit limits remain a separate check. The November notice tells providers to review each member's limits in the provider portal. The linked policy also says it does not guarantee payment. Treating the first 14 visits as an unconditional allowance could give a patient an inaccurate picture of coverage.
Prepare the handoff before visit 15
For a clinic preparing for renewal, the practical job is to make the transition visible. Assign someone to track the episode's visits and someone to submit the request when further treatment is planned. Choose a review point early enough to gather the clinical record and check the vendor's submission requirements. That review point is a clinic safeguard; the announcement does not supply a universal filing deadline.
BCBSRI says eviCore will offer two December webinars on submitting authorizations and the applicable timeframes. Use the registration link in the insurer's notice for current training details. Before the change reaches a patient's plan, the treating therapist and scheduling staff should share the same record of notification, visits used, and the status of any request for continued care.