To request prior authorization from Blue Cross & Blue Shield of Rhode Island, a provider submits the BCBS Rhode Island prior authorization form — officially the Authorization Fax Request Form — either by fax to (401) 272-8885 or through the BCBSRI provider portal, along with the member’s ID, procedure and diagnosis codes, and clinical records supporting medical necessity. Getting the channel and the documentation right the first time is what keeps the request moving instead of bouncing back for more information.
Where to Get the Form
BCBSRI hosts its prior authorization forms as downloadable PDFs on the provider forms page at bcbsri.com/providers/forms, under the “Coordination of Patient Care” section. The main ones are:
- Authorization Fax Request Form — the general-purpose form for inpatient and outpatient medical services.
- Behavioral Health Authorization Request Form — for providers who don’t have access to the MHK electronic portal.
- Infertility Treatment Form — specialized form for fertility-related preauthorization.
- Preauthorization Form for Oral Enteral Nutrition.
Radiology and cardiology authorizations don’t use a BCBSRI form at all. Those requests go through eviCore, the third-party utilization review company that handles advanced imaging on behalf of BCBSRI, and the form is downloaded from the Forms & Resources section of evicore.com.
What to Pull Together Before You Fill It Out
Have the administrative identifiers and clinical records in hand before you start the form. Missing pieces are the most common reason requests stall.
On the administrative side, you need the member’s identification number from the front of their BCBSRI card, the provider’s National Provider Identifier, the CPT or HCPCS code for the requested service, and the ICD-10 code for the diagnosis that makes the service necessary. These coded pairs let the insurer match the proposed treatment against the patient’s condition and the plan’s coverage criteria.
Codes alone won’t produce an approval. BCBSRI’s reviewers want supporting clinical evidence showing that this treatment is appropriate for this patient: recent lab results, imaging reports, physician progress notes, and documentation of any prior treatments that were tried and didn’t work. If the service is a second-line option under the plan’s policy, show what first-line care was attempted. Thin documentation is the fastest route to a denial for insufficient information, and that denial restarts the whole process.
Services That Require Prior Authorization
Not every service needs preauthorization, and the covered procedure codes change periodically. BCBSRI publishes an annual Prior Authorization for Procedures policy listing every covered CPT and HCPCS code, plus a separate Prior Authorization of Drugs policy for medications. The broad categories that generally require review:
- Inpatient admissions, including acute medical, acute rehab, and elective hospital procedures.
- Advanced imaging — MRI, CT, PET — handled through eviCore.
- Behavioral health inpatient and intermediate levels of care, including withdrawal management, crisis stabilization, residential treatment, and partial hospitalization. These require notification of both admission and discharge.
- Many specialty and prescription drugs, particularly for chronic or rare conditions.
- Various outpatient procedures identified by specific codes in the annual policy.
Each plan type has its own variations, so the member’s benefit agreement controls what truly needs preauthorization. When you’re not sure, check the plan documents or call BCBSRI’s Utilization Management team at (401) 272-5670 or 1-800-635-2477, Monday through Friday, 8:00 a.m. to 4:30 p.m.
How and Where to Submit
Pick the channel by service type. Sending a radiology request to BCBSRI’s general fax line, or a behavioral health request without the dedicated form, means the request has to be redirected before anyone reviews it.
Electronic Submission
The fastest route for most services is the BCBSRI provider portal at bcbsri.com. In-network providers and facilities can also use MHK, BCBSRI’s electronic authorization tool, for behavioral health notifications. For portal access or MHK troubleshooting, contact Provider Relations at ProviderRelations@bcbsri.org.
Medical Services (Non-Radiology)
Fax the completed Authorization Fax Request Form to (401) 272-8885, or call Utilization Management at (401) 272-5670 or 1-800-635-2477 during business hours.
Radiology and Cardiology
These go through eviCore. Submit online at evicore.com for the chance at immediate approval, call 1-888-233-8158 (Monday through Friday, 8:00 a.m. to 9:00 p.m. Eastern), or fax the eviCore form to 1-888-693-3210.
Behavioral Health
Use MHK if you have access. Otherwise, complete the Behavioral Health Authorization Request Form and fax it to 401-459-2503. BCBSRI’s behavioral health staff will follow up within three business days of receipt.
How Long a Decision Takes
Turnaround depends on the plan and the urgency.
For Medicare and Medicaid members, a CMS rule effective January 1, 2026, shortened the standard turnaround from fourteen calendar days to seven calendar days, and BCBSRI follows that timeline for routine Medicare and Medicaid requests.
For commercial plans, Rhode Island’s utilization review regulation caps standard decisions at fifteen calendar days from receipt. The insurer can extend by another fifteen days if it notifies the provider within the first window and documents a legitimate reason.
Urgent requests — where a delay could seriously harm the patient — must be decided within seventy-two hours regardless of plan type. For eviCore-handled radiology on commercial plans, routine requests are typically processed within two business days, with urgent cases held to the same seventy-two-hour standard.
Track pending requests through the same provider portal used for submission. Status will show as pending, approved, denied, or awaiting additional information; if the insurer asks for more records, the decision clock restarts when they arrive.
If the Request Looks Like It Will Be Denied
When BCBSRI’s clinical reviewer is leaning toward denial on what you submitted, the case can be escalated to a peer-to-peer review: a phone discussion between the treating physician and a BCBSRI physician reviewer. It’s a chance to explain the clinical reasoning in more detail than paperwork allows, and to resolve the case before it becomes a formal denial. Ask for the peer-to-peer when the opportunity comes up. It’s faster than appealing afterward and puts you in direct contact with the decision-maker.
If the Request Is Denied
A denial can be appealed, and the filing windows are more generous than many providers expect.
A Level 1 review can be requested in writing within 180 calendar days of the denial letter. BCBSRI issues a written decision within fifteen calendar days for pre-service denials, or fifteen business days for retrospective denials.
If Level 1 is upheld and the member has employer group coverage, a Level 2 appeal is available, again within 180 calendar days of the Level 1 decision and on the same decision timeline.
For urgent situations or members currently inpatient, call the Grievance and Appeals Unit at (401) 459-5784 or 1-800-639-2227, or fax to (401) 459-5005. Expedited decisions come within two business days or seventy-two hours, whichever is shorter.
After internal appeals are exhausted — one level for individual coverage, two for employer group — the member can request an independent external review by submitting a written request to BCBSRI within four months of the final denial. The Independent Review Organization’s decision binds the insurer.
Avoiding the Common Delays
Two mistakes cause most of the slowdowns. The first is sending the request to the wrong channel: radiology that should have gone to eviCore, or behavioral health routed around MHK and the dedicated fax. Confirm the service category before you submit.
The second is incomplete clinical documentation. A form with the right codes but no records attached will almost always come back as a request for additional information, resetting the clock. Send the clinical notes, labs, and imaging reports with the initial submission. If the plan treats the requested service as second-line, include evidence that first-line options were tried and failed. Reviewers are looking for a clear clinical story, not a code pair.
One boundary worth knowing: emergency services cannot be subject to prior authorization under the No Surprises Act, so a member who goes to the ER doesn’t need advance approval and the claim can’t be denied for lack of it.