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
Mar 1, 2024
Primary care is the backbone of the healthcare system. Primary care providers (PCPs) are usually a p...
P B F
Feb 1, 2024
As you know, February is American Heart Month, an important time to shine a spotlight on heart disea...
P B F
Jan 1, 2024
Happy New Year! As I’ve discussed before, including in last month’s column, one of our key initiativ...

BCBSRI Update

P B F
Mar 1, 2024
Every March, the Centers for Medicare and Medicaid Services (CMS) sends our members the Medicare Con...
P B F
Mar 1, 2024
BCBSRI is committed to improving health equity for our members and the healthcare system. Understand...
P B F
Mar 1, 2024
Communication Directly From Anthem:Due to a configuration error, we distributed ID cards with an inc...

Provider Relations

P B F
Mar 1, 2024
We went live in late February for the new claims on line project. Below are dates and times of live ...
P B F
Mar 1, 2024
BCBSRI invites providers to join us on Tuesday, March 12 from 10-11 a.m. for a conference call with ...
P B F
Mar 1, 2024
CMS requires participating providers to complete an annual training related to the Model of Care for...

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
Mar 1, 2024
As we head into Colorectal Cancer Awareness Month this March, we want to highlight some of the quali...
P
Feb 1, 2024
Each year, BCBSRI is required to participate in nationally recognized quality studies, called the He...
P
Jan 1, 2024
Welcome to the 2024 PCP Quality Incentive Program (PQIP) measurement year! We are excited to continu...

Behavioral Health

B
Mar 1, 2024
Non-suicidal self-injury (NSSI) is a behavior in which an individual inflicts physical harm on thems...
B
Feb 12, 2024
In honor of Eating Disorders Awareness Week, Equip Health is offering a free webinar titled – Boys &...
B
Feb 1, 2024
Celebrated annually during the last week of February, National Eating Disorders Awareness Week aims ...

Pharmacy

P F
Mar 1, 2024
Please note Avastin (J9035) does require Prior Authorization to be reviewed by Prime for Medicare me...
P
Feb 15, 2024
If you have a patient with Covid-19 who is in one of our Medicare Advantage plans and you prescribe ...
P F
Mar 1, 2023
For NEHP members with a RI PCP, inquiries regarding medical drugs should be directed to the member’s...

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
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...
P B
Nov 1, 2023
If a group submits a claim with the incorrect rendering provider, and needs to correct it, they will...

Policies

P F
Mar 1, 2024
IQ criteria updatesEffective May 1, 2024 – IQ criteria updates to the CP:Procedures Reduction Mammop...
P B F
Mar 1, 2024
The following policies were recently reviewed for annual update. The full texts of these policies ar...
P F
Mar 1, 2024
The following new policy was recently created:Suture Button Suspensionplasty Fixation System for Thu...