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
Nov 1, 2019
For a relatively small place, Rhode Island has a remarkable diversity of social and economic factors...
P B F
Oct 1, 2019
I’ve been privileged to work for Blue Cross & Blue Shield of Rhode Island (BCBSRI) for the last ...
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...

BCBSRI Update

P
Nov 1, 2019
Beginning November 1, 2019, Health Trio has been updated to change default referrals from one year t...
P
Oct 1, 2019
National Depression Screening Day, held annually on the Thursday of the first full week in October, ...
P
Oct 1, 2019
Beginning November 1, 2019, Health Trio will be updated to change default referrals from one year to...

Provider Relations

P
Nov 1, 2019
To help make the BCBSRI Provider Directory as up-to-date as possible, the Provider Directory team ha...
P B F
Oct 1, 2019
Please join us this month to learn about new and ongoing BCBSRI programs available to your patients....
P B F
Oct 1, 2019
We’ve learned about issues from some of our members regarding health reimbursement accounts (HRAs) a...

Quality

P
Nov 1, 2019
Prenatal and postpartum care (PPC) We are committed to working with you to improve the quality of c...
P
Oct 1, 2019
October is Breast Cancer Awareness Month. According to the CDC, in 2016 (the latest year for which i...
P
Sep 1, 2019
Weight assessment and counseling in children/adolescents (WCC) We are committed to working with you...

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 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 ...
P F
Aug 1, 2019
As of October 1, 2019, for commercial members, the drugs listed below will move from the specialty p...

Products & Benefits

P B F
Nov 1, 2019
In the large group portfolio, we will also be adding eight Network Blue New England Options plans, a...
P B F
Nov 1, 2019
Our regional BlueCHiP family is expanding in the small group market with the addition of Network Blu...
P B F
Nov 1, 2019
Effective January 1, 2020, BCBSRI will become the insurer for all Lifespan employees. Below is a qui...

Claims

P B F
Nov 1, 2019
Our Grievance and Appeals Unit (GAU) has been working hard to update the appeals request form and th...
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...

Policies

P F
Nov 1, 2019
Effective January 1, 2020, Transurethral Water Vapor Thermal Therapy for Benign Prostatic Hyperplasi...
P F
Nov 1, 2019
The Benign Skin Lesions and Viral Infectious Lesion Removal policy has been updated to document that...
P F
Nov 1, 2019
Effective January 1, 2020, the prior authorization requirement will be removed from Outpatient Pulmo...
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