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
Dec 1, 2023
It seems like at the end of every year we look back and say “Wow, what a year!”…and 2023 is no excep...
P B F
Nov 1, 2023
Colorectal Cancer Awareness Month is observed every March. But awareness of this disease – which is ...
P B F
Oct 1, 2023
September is Suicide Prevention Awareness Month, and May is Mental Health Awareness Month. However, ...

BCBSRI Update

P
Dec 1, 2023
Any admin user in Health Trio (person who originally set up the HT account) has the ability to creat...
P B
Dec 1, 2023
BCBSRI is actively pursuing National Committee for Quality Assurance (NCQA) Health Equity Accreditat...
P F
Dec 1, 2023
Currently, BCBSRI utilizes eviCore for High-End Radiology and Cardiology prior authorizations and Sp...

Provider Relations

P B F
Dec 1, 2023
BCBSRI invites providers to join us on Tuesday, December 12, 2023 from 11-12 p.m. for a conference c...
P B F
Dec 1, 2023
Effective January 1, 2024, all existing and new Blue RI for Duals (D-SNP) members will receive new I...
P B F
Dec 1, 2023
CMS requires participating providers to complete an annual D-SNP, or dual special needs plan, Model ...

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
Dec 1, 2023
Beginning in October 2023, providers who participate in our PCP Quality Incentive Program (PQIP) beg...
P
Nov 1, 2023
One of our medical record requesting vendors has changed their names. You may have seen requests for...
P
Nov 1, 2023
Beginning in October, providers who participate in our PCP Quality Incentive Program (PQIP) began se...

Behavioral Health

B
Dec 1, 2023
BCBSRI has collaborated with providers throughout Rhode Island to ensure that our members have acces...
B
Dec 1, 2023
The BCBSRI Behavioral Health Case Management program is staffed by experienced mental health and sub...
B
Dec 1, 2023
Per EOHHS, effective immediately,  providers can directly bill Medicaid fee for service for SUD resi...

Pharmacy

P F
Mar 1, 2023
For NEHP members with a RI PCP, inquiries regarding medical drugs should be directed to the member’s...
P F
Feb 6, 2023
For NEHP members with a RI PCP, inquiries regarding medical drugs should be directed to the member’s...
P B F
Jan 1, 2023
The Inflation Reduction Act (IRA) will take effect on January 1, 2023.The Act includes the following...

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
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...
P B
Apr 1, 2023
As a reminder, when filling out a CMS-1500 form and submitting it to BCBSRI for claims processing, i...

Policies

P F
Dec 1, 2023
Artificial Pancreas Device System     Effective February 1, 2024, we have updated the medically nece...
P B F
Dec 1, 2023
The following policies were recently reviewed for annual update. The full texts of these policies ar...
P B F
Dec 1, 2023
BCBSRI must follow CMS guidelines for national coverage determinations (NCDs) or local coverage dete...