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. Collins

P B F
Feb 1, 2020
For many years, the health system in the U.S. has been criticized for rewarding volume of services r...
P
Jan 1, 2020
Blue Cross & Blue Shield of Rhode Island (BCBSRI) is committed to improving our members’ health ...
P B F
Dec 1, 2019
Another year is quickly coming to an end, and what a year it’s been in the local healthcare landscap...

BCBSRI Update

P B F
Feb 1, 2020
As a reminder, the State of Rhode Island has two prefixes for their account. RIS (Rhode Island State...
P B F
Feb 1, 2020
BCBSRI welcomed The State of Rhode Island (identified with prefix of RIS and R2I) and Lifespan (iden...
P B F
Feb 1, 2020
When they enroll with BCBSRI, our members are granted certain rights and protections of these rights...

Provider Relations

P
Jan 1, 2020
In early 2020, due to industry security requirements, older browsers that only support TLS 1.1 or 1....
P
Dec 1, 2019
In early 2020, due to industry security requirements, older browsers that only support TLS 1.1 or 1....
P B F
Dec 1, 2019
When your office staff logs into the provider portal on bcbsri.com to verify member benefits and eli...

Quality

P
Jan 1, 2020
The following CPT Category II Codes have been updated by the American Medical Association (AMA). Ple...
P
Dec 1, 2019
As the year comes to a close, it’s time to plan for 2020. The case has been made for taking a year-r...
P
Nov 1, 2019
Prenatal and postpartum care (PPC) We are committed to working with you to improve the quality of c...

Behavioral Health

B
Jan 1, 2020
In accordance with CMS rules, effective January 1, 2020, BCBSRI will begin covering opioid treatment...
B
Jan 1, 2020
BCBSRI’s behavioral health vendor, Beacon Health Options, Inc. (Beacon), is changing the medical nec...
B
Dec 1, 2019
The HEDIS measure Antidepressant Medication Management (AMM) applies to the percentage of members wh...

Pharmacy

P F
Dec 1, 2019
As part of the annual formulary development and management process, the next scheduled update of the...
P B F
Oct 1, 2019
As part of our standard formulary management process of implementing formulary updates twice per yea...
P F
Oct 1, 2019
Effective December 1, 2019, BCBSRI will begin requiring prior authorization for an expanded list of ...

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
Feb 1, 2020
If… With a…. Going to see a…. Then…. Member has a RI NEHP plan RI PCP a RI specialist Obt...
P F
Feb 1, 2020
BCBSRI follows the Medicare National Correct Coding Initiative (NCCI) edits to ensure that all claim...
P B F
Jan 1, 2020
BCBSRI requires that all services rendered by the same provider on the same date of service to be fi...

Policies

P F
Feb 1, 2020
Effective February 1, 2020, prior authorization is now required for BlueCHiP for Medicare and recomm...
P F
Feb 1, 2020
Effective February 1, 2020, the Surgical Treatment of Snoring and Obstructive Sleep Apnea Syndrome p...
P F
Feb 1, 2020
Effective April 1, 2020, the Allergy Testing medical policy has been updated to include maximum annu...
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