In previous Provider Updates, we have consistently reached out to our network providers to remind you of your obligation, as a Blue Cross & Blue Shield of Rhode Island (BCBSRI)-contracted provider, to coordinate members’ care with contracted, in-network providers and facilities which includes, but is not limited to, clinical/pathology laboratories, durable medical equipment providers, and specialist physicians.

Here are some of the important advantages BCBSRI’s provider network offers your patients, our members:

• Lower out-of-pocket costs
• Avoiding balance billing for healthcare services
• Access to transparent pricing for procedures using BCBSRI’s cost estimator tool (located in the Provider Portal)

Additionally, all providers in our network are credentialed, which means they meet all state and federal requirements. Their contracts also ensure that they adhere to our medical and administrative policies designed to protect patients and members, and they contain provisions required by Rhode Island law and the Centers for Medicare and Medicaid Services (CMS).

All of these opportunities go a long way toward creating a simpler and more affordable healthcare system.

Before you establish a referral relationship, please confirm that the provider currently participates in BCBSRI’s network. You can check the participation status of other providers through our Find a Doctor tool.

Our provider relations and contracting teams have been working to monitor when a participating provider refers a member to a non-participating provider. An initial warning letter is sent for the first such “offense”. Following that initial letter, if another claim is found where the participating provider has referred to the same or different non-participating provider, a second letter will be sent advising the provider that BCBSRI will refer them to our Professional Advisory Committee for ongoing non-compliance with their contractual obligations.

Your cooperation is critical to ensure consistent, efficient, and affordable care for our members. If you would like more information, please reach out to Provider Relations at ProviderRelations@bcbsri.org.