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

BCBSRI Update

P B F
Apr 1, 2019
Please remember that the Grievance & Appeals Unit (GAU) only reviews appeals and does not proces...
P
Apr 1, 2019
Our Utilization Management (UM) department has streamlined the PCP admission request process for ski...
P B F
Mar 1, 2019
Please remember that the Grievance & Appeals Unit (GAU) only reviews appeals and does not proces...

Quality

P
Apr 1, 2019
The Transitions of Care (TRC) measure assesses the percentage of discharges for members age 18 or ol...
P
Mar 1, 2019
We are committed to working with you to improve the quality of care and health outcomes for our memb...
P
Feb 1, 2019
BCBSRI is committed to making it easier for your practice to be successful in all areas of quality i...

Behavioral Health

B
Apr 1, 2019
Beacon Health Options, BCBSRI’s behavioral health partner, is available 24/7 to assist with finding ...
B
Apr 1, 2019
Founded and sponsored by the National Council on Alcohol and Drug Dependence (NCADD), Alcohol Awaren...
B
Mar 1, 2019
Measure Measure population Tips for success Antidepressant Medication Management The effect...

Pharmacy

P
Apr 1, 2019
The BCBSRI Commercial formulary for April is now available. You can view the summary that provides d...
P
Mar 1, 2019
Consistent with our management practice, April 1, 2019 is the next scheduled update of the BCBSRI Co...
P
Mar 1, 2019
Effective April 1, 2019, coverage of Radicava will change from the specialty pharmacy benefit to the...

Products & Benefits

P B F
Jan 1, 2019
Effective October 1, 2018, BCBSRI launched a new product family, Access Blue New England. It will be...
P B F
Jan 1, 2019
Effective January 1, 2019, the Blue Cross and Blue Shield Federal Employee Program® (FEP) is launchi...
P B F
Jan 1, 2019
Upon enrollment, our members are granted certain rights and protection of these rights in all their ...

Claims

P B F
Apr 1, 2019
Effective April 1, 2019, BCBSRI will require the provider taxonomy code to be submitted on all claim...
P B F
Mar 1, 2019
Effective April 1, 2019, BCBSRI will require the provider taxonomy code to be submitted on all claim...
P B F
Mar 1, 2019
BCBSRI requires providers to report the name and the Type 1 National Provider Identifier (NPI) of th...

Policies

P F
Apr 1, 2019
The following new policies were recently created. Effective dates vary so please review the full tex...
P F
Apr 1, 2019
Effective December 1, 2018, the 4Kscore® Test (CPT code 81539) will be changed to a covered service ...
P F
Apr 1, 2019
The following policies were recently reviewed for annual update. The full text of these policies is ...