
How-to answers for common requests
Billing
How do I set up electronic billing and funds transfer?
ACH, or automated clearing house, is a network that coordinates payments and automated money transfers. This option is for Large Group only. Send ACH requests to your account manager.
Other groups can find electronic funds transfer (EFT) forms here.
How do I find the monthly premium bill? Can I view it online or in Excel?
Use this link to log in to your Employer portal. Once you have logged in, click “Reports,” then “Monthly Statements,” then “Group Billing Subscriber details,” then “Date.” Click on the Excel-formatted report.
How do I get help with billing for our premiums?
Call us at (401) 459-1000 ext. 6064 and choose option 1 for billing.
Where can I check on payment status?
Log into your group’s online account and click View Payment Status on the left side of the page.
View Payment Status
What is my deadline to pay my premium bill?
Premium bills are due on the first of the month following the date they are issued.
I terminated or made a change to an employee that is not reflected in my most recent bill. What do I do? Can I get a revised prorated invoice?
BCBSRI cannot issue a revised or prorated invoice. Updates made after the billing cycle has been posted for the coming month will reflect on the following month's premium statement.
Membership & Eligibility
How do I add/term/update members? Is there an online tool to do so?
Depending on the way your account is set up, you can submit changes on paper, online via the Electronic Enrollment tool, or with an electronic file. To learn what your group is set up to do, contact your account manager.
Why do some of my employees have multiple ID numbers (medical, dental, vision) and others have one?
A member may have more than one ID card because the family members on the medical and dental plans are not the same. Additionally, some employer groups have separate medical and dental groups.
How do employees obtain a temporary ID card?
Members can print a temporary ID card through their myBCBSRI account. Once they log in, they will see “Your ID Card” in the Self Service section.
How do I print a temporary card for my employee? Can I order an ID card using the Electronic Enrollment system?
ID card ordering occurs outside of the Electronic Enrollment tool. The member can print their own temporary ID card, or a request a new card, through their online account. They can log in at myBCBSRI.
What information does the member need at the pharmacy, in addition to their member ID number, if they do not have a member ID card.
Rx BIN/RxPCN 610455/BCRI RxGrp BCRI
How do I submit demographic and eligibility changes for an employee?
Depending on the way your account is set up, you can submit changes on paper, online via Electronic Enrollment, or with an electronic file. To learn what your group is set up to do, speak with your account manager.
Where can I find a copy of a Group Activity Report and Membership Application?
Use these direct links:
- Group Activity Report (GAR) and Instructions (PDF Version)
Membership Applications
- Small Group
- Large Group
How long do I have to submit changes to my eligibility (i.e. what is my retroactivity period for membership changes?)
Retroactivity is 30 days (small group) or 60 days (large group). This is measured based on the time from the qualifying event.
What happens if I need to submit a change, but I am outside of my retroactivity period?
Please contact employer support to assist with changes outside of the retroactivity period.
My group does not currently offer domestic partnership coverage. How can I add that?
The group must complete the applicable Domestic Partnership Election form for the small group or large group segment.
Benefits
How do I check on benefits, claims, and deductibles?
Call us at (401) 324-2703 ext. 6064 and choose option 3 or send us an email.
How can I access plan information, such as subscriber agreements?
Benefit documents like the Summary of Benefits are available through your group’s online account. When you log in, view the Document Center on the left side of the page. There is also a link for Subscriber Agreements. If a document is not available online, speak with your account manager.
View the Document Center
How do I get help with wellness?
Speak with your account manager. They are specially trained to answer whatever questions you might have about the details of your account.
How do employees register for the Virgin Pulse app?
They can follow these three simple steps:
- Go to VirginPulse.com or download the app*.
- Choose Blue Cross & Blue Shield of Rhode Island as the sponsor.
- Connect a Fitbit® or other wearable device to track and sync steps with the app.
*Standard mobile phone carrier and data usage charges apply. The downloading and use of the Virgin Pulse mobile app is subject to the terms and conditions of the app and the online stores from which it is downloaded. Virgin Pulse® is an independent wellness company, contracted by Blue Cross & Blue Shield of Rhode Island (BCBSRI) to provide wellness services.
Who can they contact for help with Virgin Pulse issues?
For technical support, members may call (888) 671-9395, Monday through Friday 8:00 a.m. – 9:00 p.m. Eastern.
Where can I see my Wellness Premium Reward information?
Wellness Premium Reward information is available in the reports section of your group's online account.
What do I need to do to get information about my member’s policy and claims?
Account level requests can be made by self-insured clients. For fully insured clients, member claim information requires written authorization from the member by completing a designee form on myBCBSRI. Once on file, clients may request information as indicated by the member.
Electronic Enrollment
How do I access Electronic Enrollment?
If your group is not set up with Electronic Enrollment, your account manager can help you get that implemented. If your group is set up, use this link:
Use Electronic Enrollment
Is there an Electronic Enrollment User Guide?
Yes, you can access the guide by clicking “Electronic Enrollment Guide” on the lower left of the Electronic Enrollment home page.
When I update an address using the website, do I get a transaction tracking number?
Any completed transaction done via Electronic Enrollment creates a “Thank You” page with a transaction number. If an account user clicks on the “Change Address/Request Member ID Card” option without entering Electronic Enrollment, it won't produce a “Thank You” page.
I made an error submitting a transaction using the Electronic Enrollment system. How can I void it out?
Changes submitted in the electronic enrollment tool can be cancelled within the same day. If the change was not processed as intended once it has completed processing (typically within 24-48 hours), then you may submit a new change with the corrected request either online directly in the electronic enrollment tool, or by submitting a Group Activity Report (GAR) and Instructions (PDF Version).
I submitted a change via the Electronic Enrollment system. When can I expect to see it processed?
Changes submitted in the electronic enrollment tool are typically processed within 24-48 hours. If a change requires additional documentation, then it will be pended until the documentation is received. If no documentation is received, then the electronic enrollment tool will indicate a rejection.
Account-Level Questions
How do I get help with sales-related questions?
Your account executive can help you with any of these questions.
How do I submit demographic and eligibility changes for an employee?
Depending on the way your account is set up, you can submit changes on paper, online via Electronic Enrollment, or with an electronic file. To learn what your group is set up to do, speak with your account manager.
Who can contact BCBSRI on behalf of the group?
If a client contacts us and they are not listed as a group administrator, then we can provide limited help to them as a one-time exception. No PHI is provided. We inform them that they will need to be added as a group administrator before their next contact. Otherwise, we will be unable to assist them.
How do I become a group administrator with BCBSRI?
BCBSRI requires a letter on company letterhead that is signed by an officer of the company listing you as a group administrator. The letter should indicate if you are a billing contact, enrollment contact, or both.
Large Groups - Fully Insured
Where do I find information on overall, account level claims?
You can find this information on the Employer portal. Log in to view your reports (you must be authorized to access this section). Select “Monthly Statements” then “Core Reports.” These provide a running 12-month report on claims.
Where can I find information on the financial performance of my plan?
You can access this information on the Employer portal. Log in to view your reports (you must be authorized to access this section). Select “Financial Performance,” then “Loss Ratio.” This report provides a running 12-month report of income versus claims. It does not factor in administrative costs.
What else can I find that will help me better understand my account?
You can view an executive summary, which provides a quick look at results, a population overview, geographic distribution, and demographic information.
There’s also an informative financial overview, which includes inpatient, outpatient, physician, and pharmacy cost per member, as well top 10 diagnosis categories and number and percentage of claims by dollar ranges.
Can I see utilization patterns?
Yes, you can see this type of information, which includes hospital data (days and admissions/1,000) and physician services (PCP, specialist, urgent care, and ER visits per member or per 1,000). It also features pharmacy information, including generic/brand use, Rxs per year, and cost per Rx. Top 10 generic and brand information is also supplied as well as specialty drug information and HEDIS (quality) measurements.
Can I access annual enrollment reports?
Yes. Enrollment reports provide sortable, account level enrollment information for use by accounts to prepare 1094 and 1095 reports.
Large Groups - ASC or Self-Funded
Where do I find information on individual billed claims?
You can find this information on the Employer portal. Log in to view your reports (you must be authorized to access this section). Select “Weekly” or “Monthly” statements, then “Consolidated Claims Billing.” These reports provide detailed information regarding billed claims.
Where do I find information on overall, account level claims?
You can find this information on the Employer portal. Log in to view your reports (you must be authorized to access this section). Select “Monthly Statements” then “Core Reports.” These provide a running 12-month report on claims.
Where do I find information on types of services my employees are using?
You can find this information on the Employer portal. Log in to view your reports (you must be authorized to access this section). Select “Monthly Statements.” Depending on the coverage you offer, there are a variety of reports that you can view: utilization by product, Rx specific utilization, deductible utilization, and dental utilization.
Transparency in Coverage: Machine-Readable Files
Where can I find the machine readable files?
As part of our ongoing work to improve access to pricing information and as required under the new Transparency in Coverage rule, Blue Cross & Blue Shield of Rhode Island (BCBSRI) is making available machine-readable files with provider payment information. These files will be created internally, updated monthly, and posted to bcbsri.com/developers.
Learn more by viewing these Transparency in Coverage FAQs.