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. Collins

P B F
Apr 1, 2020
The last few weeks have been an extraordinary time for all of us. This has been a remarkable challen...
P B F
Mar 1, 2020
Last month, my column focused on the attributes of high-value primary care, its importance, and its ...
P B F
Feb 1, 2020
For many years, the health system in the U.S. has been criticized for rewarding volume of services r...

BCBSRI Update

P B F
Apr 6, 2020
In conjunction with our recent announcement, Blue Cross & Blue Shield of Rhode Island (BCBSRI) i...
P B F
Apr 1, 2020
BCBSRI is in contact with government officials so we can share up-to-date information regarding the ...
F
Apr 1, 2020
Effective March 1, 2020, notification is no longer required for maternity admissions for five days o...

Provider Relations

P F
Apr 1, 2020
Effective March 18, 2020, all cost share will be waived for BCBSRI members for any telehealth/teleme...
P F
Apr 1, 2020
BCBSRI is in contact with government officials so we can share up-to-date information regarding coro...
P
Apr 1, 2020
BCBSRI is in contact with government officials so we can share up-to-date information regarding the ...

Quality

P
Jan 1, 2020
The following CPT Category II Codes have been updated by the American Medical Association (AMA). Ple...
P
Dec 1, 2019
As the year comes to a close, it’s time to plan for 2020. The case has been made for taking a year-r...
P
Nov 1, 2019
Prenatal and postpartum care (PPC) We are committed to working with you to improve the quality of c...

Behavioral Health

B
Mar 1, 2020
The HEDIS measure Follow-Up Care for Children Prescribed ADHD Medication (ADD) is the percentage of ...
B
Mar 1, 2020
The HEDIS measure Follow-Up After Hospitalization for Mental Illness (FUH) is the percentage of disc...
B
Mar 1, 2020
The HEDIS measure Antidepressant Medication Management shows the percentage of members 18 years of a...

Pharmacy

P F
Dec 1, 2019
As part of the annual formulary development and management process, the next scheduled update of the...
P B F
Oct 1, 2019
As part of our standard formulary management process of implementing formulary updates twice per yea...
P F
Oct 1, 2019
Effective December 1, 2019, BCBSRI will begin requiring prior authorization for an expanded list of ...

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 F
Apr 1, 2020
If a member receives the same radiology procedure multiple times on the same day from different prov...
P F
Apr 1, 2020
During the COVID-19 pandemic, eviCore has increased their authorization span from 90 to 180 days. An...
P F
Mar 1, 2020
ICD-10-CM provides significant improvements through greater diagnosis coding detail and the ability ...

Policies

P F
Apr 1, 2020
We have completed our review of the additional CPT and HCPCS code changes effective April 1, 2020, a...
P F
Apr 1, 2020
Effective June 1, 2020, prior authorization will be required for BlueCHiP for Medicare and recommend...
P F
Apr 1, 2020
Effective April 1, 2020, the Transcatheter Mitral Valve Repair medical policy has been updated to in...
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