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
BCBSRI Update
P B F
Oct 1, 2025
At BCBSRI, we continue to improve our members’ health and peace of mind by facilitating their access...
P B F
Oct 1, 2025
As a reminder, any claim denied with a lower case “b” has been denied by Optum. All medical records ...
P B F
Oct 1, 2025
BCBSRI has been selected for a CMS Risk Adjustment Data Validation (RADV) audit for diagnoses captur...
Provider Relations
P B F
Oct 1, 2025
BCBSRI invites providers to join us on Wednesday, October 15, from 10-11 a.m. for a conference call ...
P
Oct 1, 2025
BCBSRI specialists and Provider Relations are seeing an increase in PCP referrals being entered into...
P B F
Sep 1, 2025
BCBSRI invites providers to join us on Tuesday, September 9, from 10-11 a.m. for a conference call w...
Physician & Provider Call Center
P B F
May 1, 2025
Beginning June 1, 2025, our Provider Call Center will implement a transaction limit of five cl...
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 me...
Quality
P
Sep 1, 2025
As the year winds down and stress ramps up, it’s more important than ever to ensure accurate blood p...
P
Sep 1, 2025
Fall Prevention and the Health Outcomes Survey (HOS)Why it mattersThe Health Outcomes Survey (HOS) e...
P
Jul 1, 2025
As part of CMS’s continued focus on health equity, Functional Status Assessments (COA-FS) are transi...
Behavioral Health
B
Oct 1, 2025
Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterized by de...
B
Oct 1, 2025
NOCD is a virtual solution for BCBSRI commercial members ages five and older with a diagnosis of OCD...
B
Oct 1, 2025
Major depression is one of the most common mental health disorders, affecting more than 21 million A...
Pharmacy
P B F
Oct 1, 2025
The following drugs will require Prior Authorization beginning on October 1, 2025 for Commercial and...
P B F
Oct 1, 2025
Large Group and Small Group Markets Formulary This information is effective as of October 1, 20...
P B F
Oct 1, 2025
Tiering and formulary updates for Medicare members: 31 drugs moving off formulary 15 drugs...
Products & Benefits
P F
Aug 1, 2025
Under the Patient Protection and Affordable Care Act (PPACA), coverage is provided for many pre...
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, ...
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
Oct 1, 2025
We have completed our review of the October 2025 Healthcare Common Procedure Coding System (HCPCS) c...
P B F
Oct 1, 2025
Preventative Services for Commercial Members policyThis policy was updated to meet HRSA guidelines e...
P F
Oct 1, 2025
Cranial Orthoses (Adjustable) for Positional Plagiocephaly and Craniosynostoses &nb...