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
Jan 1, 2020
Blue Cross & Blue Shield of Rhode Island (BCBSRI) is committed to improving our members’ health ...
P B F
Dec 1, 2019
Another year is quickly coming to an end, and what a year it’s been in the local healthcare landscap...
P B F
Nov 1, 2019
For a relatively small place, Rhode Island has a remarkable diversity of social and economic factors...

BCBSRI Update

P F
Jan 1, 2020
Effective 9/23/2019, the commercial criteria for diagnostic facet joint injections includes planned ...
P B F
Jan 1, 2020
During this year’s Medicare Annual Election Period (AEP), Blue Cross & Blue Shield of Rhode Isla...
P B F
Jan 1, 2020
BCBSRI is excited to welcome two new large employer accounts as of January 1, 2020: The State of Rho...

Provider Relations

P
Jan 1, 2020
In early 2020, due to industry security requirements, older browsers that only support TLS 1.1 or 1....
P
Dec 1, 2019
In early 2020, due to industry security requirements, older browsers that only support TLS 1.1 or 1....
P B F
Dec 1, 2019
When your office staff logs into the provider portal on bcbsri.com to verify member benefits and eli...

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
Jan 1, 2020
In accordance with CMS rules, effective January 1, 2020, BCBSRI will begin covering opioid treatment...
B
Jan 1, 2020
BCBSRI’s behavioral health vendor, Beacon Health Options, Inc. (Beacon), is changing the medical nec...
B
Dec 1, 2019
The HEDIS measure Antidepressant Medication Management (AMM) applies to the percentage of members wh...

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 B F
Jan 1, 2020
BCBSRI requires that all services rendered by the same provider on the same date of service to be fi...
P
Dec 1, 2019
As a reminder, ancillary claims are filed with the local plan as follows: Lab provider: The locatio...
P B F
Dec 1, 2019
Our Grievance and Appeals Unit (GAU) has updated the appeals request form and the claims adjustment ...

Policies

P F
Jan 2, 2020
We have completed our review of the additional CPT and HCPCS code changes for January 2020. These up...
P F
Jan 1, 2020
Effective February 1, 2020, CPT code 62380 for Endoscopic decompression of spinal cord, nerve root(s...
P F
Jan 1, 2020
BCBSRI claims filed with bilateral services using modifier 50 should be filed on one line. Bilateral...
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