CommercialPrior AuthMedium impact
InterQual criteria updates
Blue Cross Blue Shield of Rhode Island·RI · Genetics, Neurology, Pediatrics +2 more·Physician / Facility
Effective date
Aug 1, 2026
We identified it
Jun 19, 2026
Summary
BCBSRI is updating InterQual criteria for molecular diagnostics including spinal muscular atrophy (SMA), whole genome sequencing, whole exome sequencing, and chromosomal microarray testing for congenital or hereditary disorders. These updates will change the medical necessity and prior authorization requirements for genetic testing services.
Action Required
By August 1, 2026: Billing team must review and implement updated InterQual criteria for molecular diagnostic testing. Contact BCBSRI for specific criteria details and update prior authorization protocols for SMA testing, whole genome sequencing, whole exome sequencing, and chromosomal microarray services. Ensure documentation meets new medical necessity requirements to prevent claim denials.