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

F
Feb 1, 2025
At BCBSRI, we continue to improve our members’ health and peace of mind by facilitating their access...
P
Feb 1, 2025
As a reminder, effective January 1, 2025, State of Rhode Island employees who have a plan with a pre...
P B F
Feb 1, 2025
Interpreter Services and Medicaid ReimbursementWe aim to ensure that patients with Limited English P...

Provider Relations

P
Feb 1, 2025
BCBSRI has temporarily waived the referral requirement for all plans for claims with a date of servi...
P B F
Feb 1, 2025
BCBSRI invites providers to join us on Tuesday, February 11, 2025 from 10-11 a.m. for a confere...
P B F
Feb 1, 2025
As a reminder, you are required as a participating provider in the D-SNP network to complete the ann...

Physician & Provider Call Center

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
Feb 1, 2025
The Consumer Assessment of Healthcare Providers and Systems (CAHPS®) is an industry standard survey ...
P
Jan 1, 2025
It’s almost that time of year again, HEDIS® medical record review time! Every year BCBSRI takes part...
P
Nov 1, 2024
Screenings for members with diabetesBCBSRI’s PQIP program currently includes three diabetes-specific...

Behavioral Health

P B
Feb 1, 2025
The BCBSRI Behavioral Health Case Management program is staffed by experienced mental health and sub...
P B
Feb 1, 2025
BCBSRI has collaborated with providers throughout Rhode Island to ensure that our members have acces...
B
Feb 1, 2025
Celebrated annually during the last week of February, National Eating Disorders Awareness Week aims ...

Pharmacy

P F
Feb 1, 2025
The following drugs will require authorization in 2025: ...
P F
Dec 1, 2024
As part of our ongoing efforts to make high-quality and affordable healthcare available to our membe...
P B F
Dec 1, 2024
The Medicare Prescription Payment Plan is a new payment option in the prescription drug law that wor...

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
Feb 1, 2025
Coding and Payment Guidelines/Modifiers Effective, January 1, 2025, modifier 27 has been added ...
P F
Feb 1, 2025
Corneal Topography, Computer Assisted Corneal Topography, PhotokeratoscopyEffective April 1, 2025, C...
P F
Feb 1, 2025
The following policies were recently reviewed for annual update. The full texts of these policies ar...