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. Manocchia

P B F
Sep 1, 2019
One of the goals of our Provider Relations team is to find new and different ways to connect with ou...
P B F
Aug 1, 2019
At Blue Cross & Blue Shield of Rhode Island (BCBSRI), it’s important to us that we help our memb...
P B F
Jul 1, 2019
One of the ways that Blue Cross & Blue Shield of Rhode Island (BCBSRI) works to control and redu...

BCBSRI Update

P
Sep 1, 2019
Beginning November 1, 2019, Health Trio will be updated to no longer default referrals to one year. ...
P F
Sep 1, 2019
MHK (formerly MedHOK) will soon serve as our new mechanism for entering prior authorization requests...
P F
Aug 1, 2019
MHK will serve as the new mechanism for entering prior authorization requests for both outpatient se...

Provider Relations

P B F
Sep 1, 2019
Please join us in October for a seminar series where you’ll learn about new and ongoing BCBSRI progr...
P B F
Aug 1, 2019
Please join us in October to learn at a seminar series about new and ongoing BCBSRI programs availab...
P B F
Jul 1, 2019
Our Provider Relations team is gathering information on various topics to present to our participati...

Quality

P
Sep 1, 2019
Weight assessment and counseling in children/adolescents (WCC) We are committed to working with you...
P
Aug 1, 2019
According to the CDC, as of April 19, 2019, a total of 186 pediatric deaths were reported to the CDC...
P
Jul 1, 2019
We are committed to working with you to improve the quality of care and health outcomes for our memb...

Behavioral Health

B
Sep 1, 2019
In ongoing efforts to increase access to behavioral health providers for our members, BCBSRI has par...
B
Sep 1, 2019
Every September, the Substance Abuse and Mental Health Services Administration (SAMHSA) sponsors Nat...
P B
Aug 1, 2019
Behavioral health providers—including psychiatrists, clinical nurse specialists, psychiatric nurse p...

Pharmacy

P F
Aug 1, 2019
As of October 1, 2019, for commercial members, the drugs listed below will move from the specialty p...
P
Aug 1, 2019
Effective July 1, 2019, both PCSK-9 products for cholesterol management—Repatha and Praluent—became ...
P
May 1, 2019
Pharmacy benefit coverage for Commercial members will be updated effective May 1, 2019 to include co...

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 F
Sep 1, 2019
As you know, CMS requires completion of a 2728 form for all newly diagnosed ESRD patients. The form ...
P F
Sep 1, 2019
Please remember to include the NPI of the servicing facility on your CMS-1500 form Box 32A. This wil...
P
Sep 1, 2019
As a reminder, in November 2018, our system was updated to allow claims to pull a referral by the pr...

Policies

P F
Sep 1, 2019
The following information has been updated in the Infertility Services policy to provide clarity. N...
P F
Sep 1, 2019
Effective November 1, 2019, digestive enzymes added to enteral formula via a cartridge device attach...
P F
Sep 1, 2019
The following policies were recently reviewed for annual update. The full text of these policies are...
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