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
Jul 1, 2026
To offer best-in-class services related to utilization management (UM) functions, we are pleas...
P B F
Jul 1, 2026
Primary care providers (PCPs) accept responsibility for arranging and coordinating members’ overall ...
P B
Jul 1, 2026
BCBSRI is actively pursuing National Committee for Quality Assurance (NCQA) Health Equity Accreditat...
Provider Relations
P B
Jul 1, 2026
We have identified claims being submitted with in-office place of service codes combined with teleme...
P B F
Jul 1, 2026
In July 2024, BCBSRI began performing additional prepayment claim reviews utilizing Optum’s Comprehe...
P B F
Jul 1, 2026
BCBSRI invites providers to join us on Tuesday, August 11, from 10-11 a.m. for a conference call wit...
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, 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...
P
May 1, 2026
The Kidney Health Evaluation for Patients with Diabetes (KED) measure is designed to ensure that adu...
Behavioral Health
P B
Jul 1, 2026
Effective May 1, 2026, InStride Health is now a nationally contracted provider within the BCBSRI net...
B
Jul 1, 2026
Healthcare Effectiveness Data and Information Set (HEDIS) is a widely used set of performance improv...
B
Jul 1, 2026
Bebe Moore Campbell National Minority Mental Health Awareness Month was established to raise awarene...
Pharmacy
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 ...
P B F
Apr 1, 2026
Large Group and Small Group Markets FormularyThe information at the link above is effective as of Ap...
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
Jul 1, 2026
Telemedicine Modifier - Claims Edit Effective 9/1/26We have identified claims being submitted with i...
P F
Jul 1, 2026
Prior authorization of spinal procedures Effective September 1, 2026, prior authorization throu...
P F
Jul 1, 2026
The following policies were recently reviewed for annual update. The full texts of these policies ar...