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
Aug 1, 2024
Last month, I briefly touched on our focus to reduce administrative burden for our participating pro...
P B F
Jul 1, 2024
It’s hard for me to believe, but I just reached the one-year mark of being at BCBSRI in late June. A...
P B F
Jun 1, 2024
In March of this year, we welcomed five more provider locations to our ever-growing network of LGBTQ...
BCBSRI Update
P B F
Jul 1, 2024
The Centers for Medicare and Medicaid Services (CMS) reminds Medicare Advantage Organizations to con...
P B
Jul 1, 2024
As a reminder, BCBSRI does not credential groups (outside of ancillary services). BCBSRI credentials...
P B F
Jul 1, 2024
Primary care providers (PCPs) accept responsibility for arranging and coordinating the overall healt...
Provider Relations
P B F
Aug 1, 2024
BCBSRI invites providers to join us on Tuesday, August 13 from 10-11 a.m. for a conference call with...
P B F
Aug 1, 2024
BCBSRI is committed to continuously improving payment integrity to prevent overpayments due to waste...
P B F
Jul 1, 2024
BCBSRI is proud to partner with our providers to help care for patients in a culturally and linguist...
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
Aug 1, 2024
What are Gap in Care (GIC) reports?Each month, BCBSRI shares important quality care gap information ...
P
Jul 1, 2024
Annual wellness visits (AWVs) are an important part of holistic preventative care. These visits are ...
P
Jun 1, 2024
The BCBSRI Quality Concierge Team is a team of nurses and highly qualified healthcare quality profes...
Behavioral Health
B
Aug 1, 2024
BCBSRI’s Behavioral Health Integration Services including the Collaborative Care Model policy has be...
B
Aug 1, 2024
BCBSRI, in partnership with Aware Recovery, is offering our in-network providers a free Continuing E...
B
Aug 1, 2024
The BCBSRI Behavioral Health Case Management program is staffed by experienced mental health and sub...
Pharmacy
P F
Aug 1, 2024
Drug Ilumya (J3256) has been listed as not needing a Prior Authorization (PA) for Commercial members...
P F
Jul 1, 2024
Drug Ilumya (J3256) has been listed as not needing a Prior Authorization (PA) for Commercial members...
P B F
Jul 1, 2024
Net Results UpdateThis information is effective as of July 1, 2024, and applies to all commercial em...
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
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
Aug 12, 2024
We have completed our review of the October 2024 Healthcare Common Procedure Coding System (HCPCS) c...
P F
Aug 12, 2024
CMS released a new code J0175 effective July 2nd, 2024. These updates will be added to our claims pr...
P F
Aug 1, 2024
Emergency Department (ED) Outpatient Facility Evaluation and Management (E/M) Coding PolicyAs part o...