Read Provider Update

This monthly newsletter delivers updates on policies, changes to benefits, and other news you need to know.

  • P = Professional
  • B = Behavioral health
  • F = Facilities

A Word from Dr. Shafi

P B F
Feb 1, 2024
As you know, February is American Heart Month, an important time to shine a spotlight on heart disea...
P B F
Jan 1, 2024
Happy New Year! As I’ve discussed before, including in last month’s column, one of our key initiativ...
P B F
Dec 1, 2023
It seems like at the end of every year we look back and say “Wow, what a year!”…and 2023 is no excep...

BCBSRI Update

P F
Feb 1, 2024
BCBSRI uses eviCore for high-end radiology and cardiology prior authorizations and spine surgery for...
P B
Feb 1, 2024
BCBSRI is actively pursuing National Committee for Quality Assurance (NCQA) Health Equity Accreditat...
P F
Feb 1, 2024
Effective April 1, 2024, there will be changes to three pharmacy codes regarding their prior authori...

Provider Relations

P B
Feb 1, 2024
In late 2023, it was announced that after the PHE ended for Medicare effective 12/31/2023, Telemedic...
P B F
Feb 1, 2024
Effective January 1, 2024, all existing and new Blue RI for Duals (D-SNP) members received new ID ca...
P B F
Feb 1, 2024
CMS requires participating providers to complete an annual training related to D-SNP, or dual specia...

Physician & Provider Call Center

P B F
Jul 1, 2023
As a reminder, there is a functionality on the BCBSRI Provider Portal that allows providers to send ...
P B F
Jun 1, 2021
  Did you know our secured Physician and Provider Portal offers the following: •Check member benef...

Quality

P
Feb 1, 2024
Each year, BCBSRI is required to participate in nationally recognized quality studies, called the He...
P
Jan 1, 2024
Welcome to the 2024 PCP Quality Incentive Program (PQIP) measurement year! We are excited to continu...
P
Dec 1, 2023
Beginning in October 2023, providers who participate in our PCP Quality Incentive Program (PQIP) beg...

Behavioral Health

B
Feb 12, 2024
In honor of Eating Disorders Awareness Week, Equip Health is offering a free webinar titled – Boys &...
B
Feb 1, 2024
Celebrated annually during the last week of February, National Eating Disorders Awareness Week aims ...
B
Feb 1, 2024
Beginning February 5, 2024, BCBSRI will no longer require a Notice of Admission for the following se...

Pharmacy

P
Feb 15, 2024
If you have a patient with Covid-19 who is in one of our Medicare Advantage plans and you prescribe ...
P F
Mar 1, 2023
For NEHP members with a RI PCP, inquiries regarding medical drugs should be directed to the member’s...
P F
Feb 6, 2023
For NEHP members with a RI PCP, inquiries regarding medical drugs should be directed to the member’s...

Products & Benefits

P B F
Dec 1, 2019
In the large group portfolio, we will also be adding eight Network Blue New England Options plans, a...
P B F
Dec 1, 2019
Our regional BlueCHiP family is expanding in the small group market with Effective January 1, 2020, ...
P B F
Dec 1, 2019
Effective January 1, 2020, BCBSRI will become the insurer for all Lifespan employees. Below is a qui...

Claims

P B F
Jan 1, 2024
BCBSRI claims department has seen an increase in claims rejecting for no eligibility because claims ...
P B F
Nov 1, 2023
If you are correcting a claim due to an audit finding, you must submit Medical Records with your cor...
P B
Nov 1, 2023
If a group submits a claim with the incorrect rendering provider, and needs to correct it, they will...

Policies

P F
Feb 7, 2024
Effective April 7, 2024, the Unlisted Procedures payment policy has been updated to reflect when a s...
P F
Feb 1, 2024
Islet Transplantation for Chronic Pancreatitis and Donislecel-jujn for Type 1 Diabetes (REVISED POLI...
P B F
Feb 1, 2024
The following policies were recently reviewed for annual update. The full texts of these policies ar...