Blue Cross & Blue Shield of Rhode Island (BCBSRI) is partnering with WINFertility who is a leader in the field of fertility services and manages thousands of patients annually. WINFertility works with drug manufacturers, specialty pharmacies, genetic testing labs and fertility specialists. WINFertility will work with providers to use the most advanced treatments to deliver the best results. WINFertility will facilitate your use of the most efficacious treatments when appropriate. They will provide case management to your members including an assessment and development of an individualized care plan, coordination of care that moves patients more rapidly to evidence-based treatment options with fewer complications and higher success rates and behavioral health support.

Providers who work closely with fertility patients, will be required to obtain authorizations through WINFertility for Commercial, fully insured members starting on October 1, 2020 instead of BCBSRI. Authorizations for self-insured clients will continue to be requested through BCBSRI. A link to WINFertility will be added to our provider portal in the same location as our other vendors. If a request is denied for fully insured members, WINFertility will send a not medically necessary denial/contract exclusion letter including appeals rights within the regulatory time frames. Appeals will be handled by the Grievance and Appeals unit at BCBSRI. If your claim denies for not obtaining an authorization, you are not allowed to bill the member and must obtain the authorization through WINFertility.

How to find if a member has a fully insured account or a self-insured account:

1. Log into BCBSRI’s secure provider portal
2. Select Patient Eligibility from the left side panel
3. Enter your BCBSRI member’s member ID, last name, first name and date of birth
4. On the medical benefits home page, there will be a selection that reads product funding which will advise you if the member has a fully or self-insured account.

Please contact Provider Relations to schedule a training on how to navigate the WINFertility site by emailing ProviderRelationsSeminars@bcbsri.org or by calling Provider Relations at 1-844-707-5627.