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 our Medical Directors

P B F
Apr 1, 2023
Gonzalo Paz-Soldán, M.D., CPE is BCBSRIs senior medical director for clinical transformation. Dr. Pa...
P B F
Mar 1, 2023
Gonzalo Paz-Soldán, M.D., CPE is BCBSRI’s senior medical director for clinical transformation. Dr. P...
P B F
Feb 1, 2023
  Matthew Collins, M.D., M.B.A. is BCBSRI’s executive vice president and chief medical officer, with...

BCBSRI Update

P F
Apr 1, 2023
Effective June 1, 2023 updates will be made in MHK for the follow subsets: - CP Procedures: Decomp...
P B F
Apr 1, 2023
At BCBSRI, we believe that high-quality care is equitable care, and we are committed to providing th...
P
Apr 1, 2023
Effective January 1, 2023, BCBSRI is updating how members in primary care provider (PCP)-required pr...

Provider Relations

P B F
Apr 1, 2023
The Centers for Medicare & Medicaid Services (CMS) reminds Medicare Advantage Organizations to c...
P B F
Apr 1, 2023
Effective January 1, 2023, all existing and new BlueRI for Duals (D-SNP) members received new ID car...
P B F
Apr 1, 2023
BCBSRI is now capturing digital contact information for providers to be published in our Provider Di...

Physician & Provider Call Center

P B F
Jun 1, 2021
  Did you know our secured Physician and Provider Portal offers the following: •Check member benef...

Quality

P
Mar 1, 2023
Measure description: The percentage of women 16-24 years of age who were identified as sexually acti...
P
Feb 1, 2023
Key measure updates: Colorectal cancer screening will widen its age range to 45-75 years of age to ...
P
Dec 1, 2022
This year, the CDC is observing National Influenza Vaccination Week from December 5-9. This month’s ...

Behavioral Health

B
Apr 1, 2023
Founded in 1987 by the National Council on Alcoholism and Drug Dependence (NCADD), National Alcohol ...
B
Apr 1, 2023
When someone is struggling with their mental health, finding the right support for them can be chall...
B
Mar 1, 2023
What is NSSI? Non-suicidal self-injury (NSSI) is a behavior in which an individual inflicts physic...

Pharmacy

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...
P B F
Jan 1, 2023
The Inflation Reduction Act (IRA) will take effect on January 1, 2023.The Act includes the following...

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, 2023
As a reminder when sending medical records to BCBSRI, a valid coversheet should be placed on top of ...
P B F
Mar 16, 2022
**This update will not take place this weekend and it will be rescheduled to a future date. **   B...
P B F
Jan 7, 2022
BCBSRI will be implementing changes to bluegateway.bcbsri.com and the system was supposed to be unav...

Policies

P F
Mar 1, 2023
We have completed our review of the April 2023 CPT code changes, including any category II performan...
P F
Mar 1, 2023
Orthognathic Surgery          Effective May 1, 2023, these services will now be medically necessar...
P B F
Mar 1, 2023
The following policies were recently reviewed for annual update. The full texts of these policies ar...