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

A Word from Dr. Shafi

P B F
Jul 1, 2024
It’s hard for me to believe, but I just reached the one-year mark of being at BCBSRI in late June. A...
P B F
Jun 1, 2024
In March of this year, we welcomed five more provider locations to our ever-growing network of LGBTQ...
P B F
May 1, 2024
As you know, May is Mental Health Month. It’s a very important time to raise awareness about the pre...

BCBSRI Update

P B F
Jul 1, 2024
The Centers for Medicare and Medicaid Services (CMS) reminds Medicare Advantage Organizations to con...
P B
Jul 1, 2024
As a reminder, BCBSRI does not credential groups (outside of ancillary services). BCBSRI credentials...
P B F
Jul 1, 2024
Primary care providers (PCPs) accept responsibility for arranging and coordinating the overall healt...

Provider Relations

P B F
Jul 1, 2024
BCBSRI is proud to partner with our providers to help care for patients in a culturally and linguist...
P B F
Jul 1, 2024
BCBSRI invites providers to join us on Tuesday, August 13 from 10-11 a.m. for a conference call with...
P B
Jul 1, 2024
BCBSRI has seen an increase in claims processed by out-of-network providers or laboratories which we...

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 member benef...

Quality

P
Jul 1, 2024
Annual wellness visits (AWVs) are an important part of holistic preventative care. These visits are ...
P
Jun 1, 2024
The BCBSRI Quality Concierge Team is a team of nurses and highly qualified healthcare quality profes...
P
Apr 1, 2024
The first seven to 30 days following hospital discharge can be an overwhelming transition for patien...

Behavioral Health

B
Jul 10, 2024
Blue Cross & Blue Shield of Rhode Island, in partnership with Aware Recovery, is offering our in...
B
Jul 1, 2024
The BCBSRI Behavioral Health Case Management program is staffed by experienced mental health and sub...
B
Jul 1, 2024
Healthcare Effectiveness Data and Information Set (HEDIS®) is a widely used set of performance impro...

Pharmacy

P F
Jul 1, 2024
Drug Ilumya (J3256) has been listed as not needing a Prior Authorization (PA) for Commercial members...
P B F
Jul 1, 2024
Net Results UpdateThis information is effective as of July 1, 2024, and applies to all commercial em...
P
Jun 1, 2024
Fluticasone HFA has been added to all BCBSRI commercial formularies as a preferred tier medication. ...

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
Jul 1, 2024
Updates were made that impact HCPCS codes J1748, J8611, J8612, Q5137. Please refer to details below....
P F
Jul 1, 2024
We have completed our review of the July 2024 CPT code changes, including any category II performanc...
P F
Jul 1, 2024
Emergency Department (ED) Outpatient Facility Evaluation and Management (E/M) Coding PolicyAs part o...