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, 2026
To offer best-in-class services related to utilization management (UM) functions, we are pleased to ...
P F
Aug 1, 2026
Effective July 1, 2026, Astrana Health transitioned to a new utilization management system. Pro...
P
Jul 13, 2026
Effective July 13th, eviCore will no longer allow authorizations to be entered into their authorizat...
Provider Relations
P B
Aug 1, 2026
We have identified claims being submitted with in-office place of service codes combined with teleme...
P B F
Aug 1, 2026
Join us for a call with the BCBSRI Provider Relations team BCBSRI invites providers to j...
P B
Jul 1, 2026
We have identified claims being submitted with in-office place of service codes combined with teleme...
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
Aug 1, 2026
Understanding diabetic measuresKidney Health Evaluation for Patients with Diabetes (KED), Glycemic S...
P
Jul 1, 2026
Understanding the CAHPS SurveyThe Consumer Assessment of Healthcare Providers and Systems (CAHPS) is...
P
Jun 1, 2026
Understanding the Health Outcomes Survey (HOS) The Health Outcomes Survey (HOS) is a feder...
Behavioral Health
B
Aug 1, 2026
Healthcare Effectiveness Data and Information Set (HEDIS) is a widely used set of performance improv...
P B
Aug 1, 2026
Grow Therapy is a virtual behavioral health provider group that connects members with licensed clini...
P B
Aug 1, 2026
The BCBSRI Behavioral Health Case Management program is staffed by experienced mental health and sub...
Pharmacy
P F
Aug 1, 2026
Effective September 1, 2026, iDose TR (J7355) and Durysta (J7351) will require prior authorization u...
P F
Jul 1, 2026
Effective September 1, 2026 iDose TR (J7355) and Durysta (J7351) will require a prior authorization ...
P F
Apr 1, 2026
The following drugs will require PA effective April 1, 2026 ...
Products & Benefits
P
Nov 1, 2025
Under the Patient Protection and Affordable Care Act (PPACA), coverage is provided for many pre...
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...
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 B F
Aug 1, 2026
Telemedicine modifier - Claims edit effective September 1, 2026 We have identified claims...
P F
Aug 1, 2026
Interferential Current StimulationEffective October 1, 2026, service will change from covered to not...
P
Aug 1, 2026
The following new policies were created. Effective dates vary so please review the full text of thes...