Provider Update
Sharing news and information
In our monthly newsletter, you and your staff will find important updates on policies, benefits, events, and more.
7 ways BCBSRI supports you and your patients
You care for our members, and we’re here to help every step of the way.
See the resources available- P = Professional
- B = Behavioral health
- F = Facilities
BCBSRI Update
P F
Nov 1, 2026
As of January 1, 2027 there will be updates to the following InterQual Criteria subsets: CP: Pr...
P B F
Nov 1, 2026
Propio is BCBSRI’s new interpreter vendor replacing all current interpreter vendors we use today. Pr...
P B F
Nov 1, 2026
BCBSRI’s Safe Zone Program recognizes healthcare practices and community-based organizations formall...
Provider Relations
P B F
Nov 1, 2026
BCBSRI invites providers to join us on Tuesday, November 10, from 10-11 a.m. for a conference call w...
P B F
Nov 1, 2026
Coming soon, the View Claim Status screen within the Provider Portal will look a little different.&n...
P B F
Nov 1, 2026
As a reminder, all Blue Cross & Blue Shield of Rhode Island (BCBSRI) participating provide...
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
Nov 1, 2026
Why accurate blood pressure readings matter The Controlling High Blood Pressure (CBP) measure e...
P
Oct 1, 2026
The Health Outcomes Survey (HOS) is an important Medicare survey that helps capture members’’ experi...
P
Sep 1, 2026
Osteoporosis Management in Women (OMW) is a Medicare Advantage HEDIS measure focused on women a...
Behavioral Health
B
Nov 1, 2026
National Caregiver Month is a time to recognize and honor the millions of Americans who provide care...
P B
Nov 1, 2026
The BCBSRI Behavioral Health Case Management program is staffed by experienced mental health and sub...
P B
Nov 1, 2026
BCBSRI has collaborated with providers throughout Rhode Island to ensure that our members have acces...
Pharmacy
P F
Nov 1, 2026
Did you know that we offer a fast and seamless electronic way to submit requests for pharmacy drug t...
P B F
Nov 1, 2026
BCBSRI and Prime Therapeutics will transition from SimplicityRx to JudiRx to administer the Medicare...
P B F
Oct 1, 2026
BCBSRI and Prime Therapeutics will transition from SimplicityRx to JudiRx to administer the Medicare...
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 F
Nov 1, 2026
Pharmacy Post Claim Review MedicationsThe MPS list for both Commercial and Medicare plans within the...
P F
Nov 1, 2026
*Implementation of New Medical Policy is on Hold: Joint Replacement, ShoulderFurther Information to ...
P F
Nov 1, 2026
The following policies were recently reviewed for annual update. The full texts of these policies ar...