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
May 1, 2025
To offer best-in-class services related to utilization management (UM) functions, we are pleased to ...
P
May 1, 2025
When a patient receives a cancer diagnosis, their world is turned upside down—and their care needs e...
P B F
May 1, 2025
As a reminder, D-SNP member ID cards do not display the copays or coinsurance. D-SNP members have a ...
Provider Relations
P F
May 1, 2025
At BCBSRI we continue to improve our members’ health and peace of mind by facilitating their access ...
P B F
May 1, 2025
BCBSRI invites providers to join us on Tuesday, May 13, 2025 from 10-11 a.m. for a conference call w...
P B F
Apr 1, 2025
BCBSRI invites providers to join us on Tuesday, April 8, 2025 from 10-11 a.m. for a conference call ...
Physician & Provider Call Center
P B F
May 1, 2025
Beginning June 1, 2025, our Provider Call Center will implement a transaction limit of five cl...
P B F
Jul 1, 2023
As a reminder, there is a functionality on the BCBSRI Provider Portal that allows providers to send ...
P B F
Jun 1, 2021
Did you know our secured Physician and Provider Portal offers the following:
•Check me...
Quality
P
Apr 1, 2025
The Healthcare Effectiveness Data and Information Set (HEDIS) is a tool developed by the National Co...
P
Mar 1, 2025
The Centers for Medicare and Medicaid Services (CMS) has introduced two new Part D Star Measures for...
P
Feb 1, 2025
The Consumer Assessment of Healthcare Providers and Systems (CAHPS®) is an industry standard survey ...
Behavioral Health
P B
May 1, 2025
Celebrated annually in May, Mental Health Month provides an opportunity to promote awareness, offer ...
B
May 1, 2025
The BCBSRI Behavioral Health Case Management program is staffed by experienced mental health and sub...
B
May 1, 2025
BCBSRI has collaborated with providers throughout Rhode Island to ensure that our members have acces...
Pharmacy
P F
Apr 1, 2025
The following drugs will require PA effective 4/1/25...
P B F
Mar 1, 2025
Large Group and Small Group Markets FormularyThe information below is effective as of April 1, 2025,...
P F
Feb 1, 2025
The following drugs will require authorization in 2025:Drug NameGenericCodeMedicare Effective DateCo...
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
Apr 1, 2024
BCBSRI is not a PPO network sharing plan. We are not allowed to price based on our participating pro...
P B F
Jan 1, 2024
BCBSRI claims department has seen an increase in claims rejecting for no eligibility because claims ...
P B F
Nov 1, 2023
If you are correcting a claim due to an audit finding, you must submit Medical Records with your cor...
Policies
P F
May 1, 2025
DRG Mapping PolicyWe updated the description within the policy and added the following statement. No...
P F
May 1, 2025
Biomarker Testing in Risk Assessment and Management of Cardiovascular Disease  ...
P F
May 1, 2025
Effective July 1, 2025, updates will be made in the online authorization tool for the following Inte...