May 1, 2022

Direct Pay Claims Pending

Your office could see an increase time for claims processing for some Direct Pay member claims. If a Direct Pay member owes their premium to BCBSRI, their claims will be pended until a payment is received or BCBSRI terminates the member's membership. 

  • The time period for suspension increased due to COVID and will continue until the current PHE is removed
  • Claims could suspend for up to 150 days
  • In the timeframe, the provider does not have a denial and cannot bill the member until the claim is released for payment or the claim has denied for termination of coverage