11/5/26
Blue Cross & Blue Shield of Rhode Island has announced that, starting January 1, 2027, patients in its fully insured commercial plans will need eviCore approval before and during physical and occupational therapy. APTA Rhode Island is working to protect timely access to care for these patients. Here is what you need to know and what you can do.
What’s changing
Who: BCBS RI fully insured commercial members. Self-funded employer plans are not included.
When: January 1, 2027.
What: an eviCore “notification” for visits 1 to 14 of each episode of care, then prior authorization from visit 15. eviCore will also manage all appeals.
Already in place: BCBS RI Medicare Advantage (Blue Chip) members have had this process since January 1, 2026.
Why it matters
It’s called a notification, but it’s the same work as an authorization. Every submission takes the same paperwork, clinical documentation and staff time as a prior authorization. It applies to every patient, starting with the first visit.
We already know how this works. BCBS RI put the same process in place for its Medicare Advantage members this year. For every patient, practices now complete the same paperwork as a full authorization before care can begin. That work adds cost, delays treatment and takes clinicians’ time away from patients.
Practices have almost no time to prepare. BCBS RI gave 61 days’ notice. The medical policy listing affected codes hasn’t been published, and eviCore’s only training sessions are December 22 and December 30, days before the change takes effect.
It runs against Rhode Island’s direction. The Office of the Health Insurance Commissioner (OHIC) required insurers to cut prior authorization by 20% by the end of 2026. State law has already removed prior authorization for services ordered by primary care providers. Physical therapy patients deserve the same.
Delays cost more later. Barriers to starting physical therapy push patients toward imaging, injections, specialist visits and surgery.
What APTA Rhode Island is doing
APTA-RI has met with BCBS RI leadership and asked in writing for alternatives to this expansion. We are now raising it with BCBS RI’s senior medical leadership, OHIC and the General Assembly. Our goals are to change the program before it starts and to secure lasting protection for timely access to physical therapy in the 2027 legislative session.
What you can do
Click on letter template below that is closest to you. Please be sure to fill in anything in ( )
Share a patient story. Tell us how authorization has affected a patient’s care this year: a delay, a gap between visits, or someone who stopped treatment. Remove all identifying details and have the patient’s consent.
A note on our advocacy
APTA Rhode Island advocates on public policy to regulators, legislators and the public. We do not discuss or coordinate payment rates, contract terms or decisions about contracting with any insurer. Each practice makes those decisions independently.
Questions
Does this affect my Blue Chip (Medicare Advantage) patients? They have been under this process since January 1, 2026. The 2027 change extends it to fully insured commercial plans.
Does it apply to self-funded employer plans? No. The notice applies to fully insured commercial plans only. Check each patient’s plan.
Does it apply to occupational therapy? Yes. The notice covers both physical and occupational therapy.
Where can I learn the eviCore process? eviCore is holding webinars on December 22 (2:30 to 3:30 pm) and December 30 (11:00 am to 12:00 pm). Register through eviCore’s webinar page. Questions about the change go to BCBS RI Provider Relations at 1-844-707-5627 or ProviderRelations@bcbsri.org.
Questions? Contact riapta@libertysquaregroup.com