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 F
Jun 1, 2026
We are aware of Anthem member claims denying with the explanation that the provider is contracted di...
P B F
Jun 1, 2026
To offer best-in-class services related to utilization management (UM) functions, we are pleased to ...
P F
Jun 1, 2026
As a reminder, Astrana Health (formally Prospect) changed their telephone numbers on May 5, 2026. Ph...
Provider Relations
P B F
Jun 1, 2026
As a reminder, providers, provider offices, and facilities are not allowed to bill members up-front ...
P B F
Jun 1, 2026
BCBSRI invites providers to join us on Tuesday, June 9, from 10-11 a.m. for a conference call with t...
P B F
Jun 1, 2026
According to California Blue Cross, plans for Charter Care/Astrada Health were terminated effective ...
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
May 1, 2026
The Kidney Health Evaluation for Patients with Diabetes (KED) measure is designed to ensure that adu...
P
Apr 1, 2026
The Follow-up After Emergency Department Visit for People with High-Risk Chronic Conditions (FM...
P
Feb 1, 2026
The Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey season begins in March, a...
Behavioral Health
B
Jun 1, 2026
Today, over seven million Americans are living with Alzheimer’s disease. The disease primarily impac...
P B
Jun 1, 2026
The BCBSRI Behavioral Health Case Management program is staffed by experienced mental health and sub...
P B
Jun 1, 2026
BCBSRI has collaborated with providers throughout Rhode Island to ensure that our members have acces...
Pharmacy
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...
P F
Apr 1, 2026
The following brand name and generic drugs with preferred alternatives be excluded from coverag...
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
May 18, 2026
Effective 4/1/2026, New HCPCS Code C8010 will be covered for Medicare Advantage Plans. No change to ...
P F
May 13, 2026
We have completed our review of the July 2026 current procedural terminology (CPT) including any cat...
P F
May 1, 2026
Non-Reimbursable Health Service Codes Policy 2026 Effective April 1, 2026 the below codes were ...