Frequently Asked Questions

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Plans & Services

Typically, your renewal is on the anniversary date of your plan's initial effective date. For example, if your plan became effective on January 1, 2009, your renewal would be January 1, 2010.

Healthcare Fraud

Blue Cross prevents and identifies fraud by analyzing data and collaborating with outside organizations.

In addition to fraud reported by members or doctors, Blue Cross also prevents and identifies fraud by:

  • Analyzing data – We are implementing new, highly sophisticated fraud detection software to further analyze claims data and identify unusual billing patterns of medical procedures, and any patterns of potentially fraudulent behavior.
  • Collaborating with outside organizations – When appropriate, we work with the National Health Care Anti-Fraud Association, the Blue Cross and Blue Shield Association, law enforcement agencies, and public and private organizations to stop fraudulent activities.
     

You can protect yourself from fraud by safeguarding your member ID card and Social Security number, being wary of “free” services, and verifying your Explanation of Benefits statements.

Here are three simple ways you can protect yourself from fraud:

  1. Safeguard your insurance ID card and Social Security number. This helps prevent someone else from using your member ID card to receive services.
  2. Beware of “free” services, especially if you’re asked to provide your insurance ID card. The service may not be free and could be fraudulently charged to you or your insurance company.
  3. Compare your Explanation of Benefits statements to your medical bills to verify the reasons and costs for any services you receive. Fraud may involve you being billed for services you never received or services different from the ones you actually received. Log in to view Explanation of Benefits statements.

In 2012, we continued to enhance our efforts in investigating and detecting fraud and abuse—and saved over $3.3million. That’s a savings of approximately $4.50 for every dollar we invested in fraud detection. We researched more than 180 fraud cases and referrals.

HIPAA Security & Privacy for Employers

The HIPAA Security Regulation defines specific standards and controls that must be in place to protect the confidentiality, integrity, and availability of electronic protected health information (ePHI). ePHI is information transmitted over the Internet and/or stored on a computer, CD, disk, magnetic tape, or other related means. This includes ePHI that is created, received, maintained, or transmitted. You can find the final Security Rule in the Federal Register of February 20, 2003.
 

Any covered entity (healthcare provider, healthcare plan and healthcare clearinghouse) that files claims or receives remittance advices electronically must comply with the HIPAA Security Regulation. Please consult your legal counsel to determine your obligations. 

Blue Cross & Blue Shield of Rhode Island (BCBSRI) insures that our business practices comply with the security regulations. Some of the activities completed include:

  • Appointment of an information security official and privacy official
  • Routine risk assessments
  • Creating and/or modifying existing security and privacy policies/procedures
  • Entering into business associate contracts with key vendors
  • Executing a security and privacy awareness training program for our workforce
     

Several reputable agencies and organizations have posted helpful information about HIPAA Security on their Web sites:

  • The Centers for Medicare and Medicaid Services (CMS), the enforcement agency for HIPAA Security, has a section devoted to security education materials.
  • The U. S. Government Printing Office Web site has a link to the Federal Register (February 20, 2003) containing the final Security Rule.
  • The Workgroup for Electronic Data Interchange (WEDI), has information and links to other HIPAA resources.

We hope this information will assist you in your efforts to comply with the HIPAA Security Rule. If you would like to discuss how this new law will affect the way you communicate with BCBSRI, please contact your account executive.

Pharmacy

You may use any of the 60,000 participating pharmacies in our network. To change your prescription to a new pharmacy, you can:

1. Bring your prescription bottle(s) to the new participating pharmacy. The pharmacist will contact your previous pharmacy and arrange for your prescriptions to be transferred.
-OR-
2. Request a new written prescription from your doctor, and bring it to the new pharmacy to be filled.

First log in to the secure site, then click on Pharmacy from your member page. (If you don’t already have a login account, click on “Create a New Account”.) You will have access to a variety of pharmacy tools and information.