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
Jun 1, 2025
To offer best-in-class services related to utilization management (UM) functions, we are pleased to ...
P B F
Jun 1, 2025
The latest Dual Special Needs Plan (D-SNP) Model of Care (MOC) evaluation and other performance resu...
P B F
May 1, 2025
To offer best-in-class services related to utilization management (UM) functions, we are pleased to ...
Provider Relations
P B F
Jun 1, 2025
BCBSRI invites providers to join us on Tuesday, June 10, from 10-11 a.m. for a conference call with ...
P B F
Jun 1, 2025
Beginning June 1, 2025, our Provider Call Center implemented a transaction limit of five claims.&nbs...
P F
May 1, 2025
At BCBSRI we continue to improve our members’ health and peace of mind by facilitating their access ...
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
Jun 1, 2025
The Medicare Health Outcomes Survey (HOS) will be mailed to members beginning in July and through No...
P
Apr 1, 2025
The Healthcare Effectiveness Data and Information Set (HEDIS) is a tool developed by the National Co...
P
Mar 1, 2025
The Centers for Medicare and Medicaid Services (CMS) has introduced two new Part D Star Measures for...
Behavioral Health
P B
Jun 1, 2025
BCBSRI has collaborated with providers throughout Rhode Island to ensure that our members have acces...
P B
Jun 1, 2025
The BCBSRI Behavioral Health Case Management program is staffed by experienced mental health and sub...
B
Jun 1, 2025
Across the world, more than 55 million people are living with Alzheimer’s disease or another form of...
Pharmacy
P B F
Jun 1, 2025
Large Group and Small Group Markets Formulary The information below is effective as of July 1, ...
P F
Apr 1, 2025
The following drugs will require PA effective 4/1/25...
P B F
Mar 1, 2025
Large Group and Small Group Markets FormularyThe information below is effective as of April 1, 2025,...
Products & Benefits
P B F
Dec 1, 2019
In the large group portfolio, we will also be adding eight Network Blue New England Options plans, a...
P B F
Dec 1, 2019
Our regional BlueCHiP family is expanding in the small group market with Effective January 1, 2020, ...
P B F
Dec 1, 2019
Effective January 1, 2020, BCBSRI will become the insurer for all Lifespan employees. Below is a qui...
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
Jun 1, 2025
Emergency Department Outpatient Facility Evaluation and Management Coding This policy was updat...
P B F
Jun 1, 2025
Laboratory Testing Investigational ServicesEffective August 1, 2025, CPT codes 0371U, 0372U, 0373U, ...
P F
Jun 1, 2025
The following policies were recently reviewed for annual update. The full texts of these policies ar...