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
Aug 1, 2025
BCBSRI has been selected for a CMS Risk Adjustment Data Validation (RADV) audit for diagnoses captur...
P B F
Aug 1, 2025
To offer best-in-class services related to utilization management (UM) functions, we are pleased to ...
P B F
Jul 1, 2025
The Centers for Medicare and Medicaid Services (CMS) reminds Medicare Advantage Organizations to con...
Provider Relations
P B F
Aug 1, 2025
BCBSRI invites providers to join us on Tuesday, August 12, from 10-11 a.m. for a conference call wit...
P B F
Jul 1, 2025
NOTE: There will be no conference call in July.BCBSRI invites providers to join us on Tuesday, Augus...
P B F
Jun 1, 2025
BCBSRI invites providers to join us on Tuesday, June 10, from 10-11 a.m. for a conference call with ...
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
Jul 1, 2025
As part of CMS’s continued focus on health equity, Functional Status Assessments (COA-FS) are transi...
P
Jun 1, 2025
The Medicare Health Outcomes Survey (HOS) will be mailed to members beginning in July and through No...
P
Apr 1, 2025
The Healthcare Effectiveness Data and Information Set (HEDIS) is a tool developed by the National Co...
Behavioral Health
P B
Aug 1, 2025
BCBSRI has collaborated with providers throughout Rhode Island to ensure that our members have acces...
P B
Aug 1, 2025
The BCBSRI Behavioral Health Case Management program is staffed by experienced mental health and sub...
B
Jul 1, 2025
BCBSRI has collaborated with providers throughout Rhode Island to ensure that our members have acces...
Pharmacy
P F
Aug 1, 2025
The following drugs will require Prior Authorization beginning on August 1, 2025 for Commercial only...
P B F
Jul 1, 2025
Large Group and Small Group Markets Formulary The information below is effective as of July 1, ...
P F
Jul 1, 2025
The following drugs will require PA effective July 1, 2025. ...
Products & Benefits
P F
Aug 1, 2025
Under the Patient Protection and Affordable Care Act (PPACA), coverage is provided for many pre...
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, ...
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
Aug 1, 2025
Laboratory Tests Post Transplant and for Heart Failure Effective August 1, 2025: CP...
P F
Aug 1, 2025
The following policies were recently reviewed for annual update. The full texts of these policies ar...
P F
Aug 1, 2025
The following new medical policy was created: Acute Hepatitis Panel – Effective October 1, 2025...