Bcbsri provider benefits Effective dates vary so please review the full text of these policies in the Provider section of BCBSRI. ; Medicare Supplement Help cover costs with a Plan 65 ^Additional Benefits are available to members who have selected a High-Value Provider as their Primary Care Provider. Requests for authorization of genetic testing should be submitted via the BCBSRI online prior authorization tool, which is available to BCBSRI-participating providers. Please refer to the The information in My Health Toolkit® can help you understand your health plan benefits. And when you select a High-Value BlueRI for Duals provides additional benefits and supports to both members and providers. The benefit information provided is a summary of what we cover and what you pay. Navigation. This plan offers a Point-of-Service benefit meaning you can use providers outside the plan’s network for an additional cost on some services. On October 1, 2019, Blue Cross & Blue Shield of Rhode Island (BCBSRI) will launch a new version of its New England Health Plan (NEHP) product called Network Blue New England Options. , more. $7,500 annually for services you receive from out-of-network providers. to obtain “Treatment, Payment, and Your primary care provider (PCP) can coordinate your care with specialists, labs, hospitals, and any other providers you might need. We’ll explain everything you need to know about the $0 benefits that come with our BlueCHiP for Medicare (HMO-POS) plans and the extra benefits you could get if you qualify for Extra Help or Blue Cross & Blue Shield of Rhode Island (BCBSRI) is providing these templates as a courtesy to our valued employers, as a way to better communicate with your employees about important information regarding their health plan. Services are covered under the member durable medical equipment benefit and the services do not require prior BCBSRI has seen an increase in claims processed by out-of-network providers or laboratories which were referred by a participating BCBSRI provider. COM Benefits may vary between groups/contracts. Please refer to your policy for specific benefits. Headway will join BCBSRI’s network as a virtual provider group that delivers quality mental health care Send the claim to BCBSRI with the primary member ID first. Jan 1, 2024. Learn about the upcoming changes to Medicare Advantage plans and pharmacy benefits for 2025, including new plans, tiering, formulary updates, and coverage exceptions. ; Medicare Supplement Help cover Sign in to myBCBSRI to see your claims, benefits, and account information. This means we require BCBSRI-contracted providers to BCBSRI must follow CMS guidelines for national coverage determinations (NCDs) or local coverage determinations (LCDs). O. com provider porta P B F . If you have any questions In previous Provider Update issues, we’ve consistently reached out to our provider community to remind you of your obligation, as a Blue Cross & Blue Shield of Rhode Island (BCBSRI) Flexible Benefit Card, gym membership, and BCBSRI providers can view authorizations in the MHK provider portal by expanding the drop-down and selecting “View UPDATE 12/5/2024 *CPT codes 0913T, 0914T, 0915T, 0916T, 0917T, 0918T, 0923T, 0933T will not require prior authorization with (Cardiology and Radiology vendor) for Medicare Advantage Medicare Advantage See all your options, compare plans, and enroll. COM. (401) 274-4848 WWW. This update will change the methadone maintenance benefit to the following: Click here for a Provider Identification Number (PIN). Overview; Shop; Why choose BCBSRI? Insurance basics; Insurance through an employer? BCBSRI’s 2024 D-SNP Model of Care Provider Training Dates: Tuesday, December 5, 2023 from 12-1 p. Therefore, policies for BlueCHiP for Medicare may differ from policies for commercial products. High-Value Provider network consists of Care New BCBSRI invites providers to join us on Tuesday, March 12 from 10-11 a. org prior to the meeting. We are currently beginning the pilot stage of our testing and are hoping to go live for all providers in January of 2024. Primary care Coming soon BCBSRI will be introducing online web claim submission through bcbsri. This means that BCBSRI providers will not be able to refer BCBSRI or members of other Blue Plans who are receiving services Despite those benefits, it has been identified nationally as a cause of unnecessary delays in getting care, being inefficient, and causing frustration for providers as well as patients. For example- $3000 a year in dental coverage, $275 per quarter OTC card, $300 vision hardware, 50 one way rides to medical For BlueRI for Duals Provider FAQ BlueRI For Duals, Quick Facts Link to BlueRI for Duals 2024 Flyer: BMED-962947_2024_Duals_(DSNP)_Prospect_Flier_FA2. If you use the providers that are not in our network, the plan may not pay for these services. for a conference call with the Provider Relations team, who will provide updates and Comprised of the member and/or caregiver, providers, and BCBSRI care team. Provider Update, April 2024 . May 1, 2024. The SBC shows you how you and the plan would a network provider? Yes. We made changes to our telemedicine/telephone For any other provider inquiries not associated with this training, please email ClientServices@evicore. Nationwide provider network—a big plus for individuals who travel often or split their time between homes; Flexible Benefit Card, gym membership, and BCBSRI requires that participating providers who treat or diagnose patients for substance use disorders or refer patients for treatment of substance use disorders and are subject to the Confidentiality of Substance Use Disorder Patient Records Rule [(42 CFR. Learn more about your plan options. manager, Prime In the BCBSRI MHK Provider Portal, providers will now have the ability to add a six-digit extension to their contact phone number. diagnostic test of the individual’s germline will benefit the individual and one of the following criteria is met: violation of this policy and severe action will be taken up to and including termination from the BCBSRI provider network. 2. Provider Update, April 2021 . ” Only about 15% of members entered Stage 2 in 2022. What information are you looking for? The information in My Health Toolkit® can help you understand your health plan benefits. Log in to access your member portal, shop plans, or get help with COVID-19. EFFECTIVE DATE: 01 |01 2025 . Oct 1, 2024. Your guide to better health at Blue Cross Blue Shield of Rhode Island. Providers can perform various actions Flexible Benefit Card, gym membership, and other benefits Start here. Evaluation & Management services; Please be advised that BCBSRI is updating its reimbursement for evaluation and management (E&M) services for all primary care providers (PCP), as well as specialist providers. If the member has a PPGRI PCP, you will be transferred to 500 EXCHANGE STREET, PROVIDENCE, RI 02903-2699 MEDICAL COVERAGE POLICY | 3 (401) 274-4848 WWW. For drug specific prior authorization details, please refer to the drug criteria in the provider administered medication criteria section: Prior Authorization This plan uses a provider network. You can view our plan’s from in-network providers. The hospital discharge planner will help coordinate this benefit. BCBSRI invites Become a participating provider Use this form to add a new practice or a new provider within a practice. We will soon begin publishing provider race and ethnicity in our Find a Doctor provider directory on bcbsri. If a laboratory provides a laboratory service that has not been authorized, the service will Participation in the BCBSRI Patient Centered Medical Home (PCMH) and System of Care (SOC) value based programs offers both provider and member level benefits, which may include enhanced provider payment and/or reduced member liability. Secure messaging is located on the left Flexible Benefit Card, gym membership, and other benefits Start here. At this time BCBSRI does not require non-skilled home care agencies to be Medicare certified. Provider Update, February 2023 . BCBSRI invites providers The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. Please refer to the appropriate New: The benefit limit is $1,500 per hearing aid per occurrence. As part of our overall efforts to support primary care in Rhode Island, BCBSRI realized we needed to do something to address this situation. In some instances, benefits for BCBSRI invites providers to join us on Tuesday, August 13 from 10-11 a. org. The BCBSRI invites providers to join us on Tuesday, November 14, 2023 from 10-11 a. Manage Your Plan; Prescription Drugs; Find Care; See Plan Perks; Live Healthy PROVIDENCE, RI (October 15, 2020) – Blue Cross & Blue Shield of Rhode Island (BCBSRI) $0 primary care provider visits at patient-centered medical homes (PCMHs) $0 rides to the doctor, senior centers, libraries and Your Blue Store SM locations; It also includes a number of new benefits, which are available with all BCBSRI Medicare diagnostic test of the individual’s germline will benefit the individual and one of the following criteria is met: violation of this policy and severe action will be taken up to and including termination from the BCBSRI provider network. com or by calling the Provider Service Center at 401-274-4848 or 1-800-230-9050 prior to requesting any Flexible Benefit Card, gym membership, and other benefits Start here. Fill out the required information & click “Go. Provider Update, January 2018 . Please refer We encourage you to submit any questions you would like addressed during the call to ProviderRelationsSeminars@bcbsri. Effective January 1, 2014, Pediatric Services including oral care has been defined as an Essential Health Benefit. $10,000 annually for services you receive from out-of-network providers. See Understanding your benefits Provisions $1,500– annual maximum per member $0 deductible per individual plan $0 deductible per family plan Dependents covered until age 26 When you visit Find health plans, benefits, and resources for individuals, families, employers, and providers in Rhode Island. Additional Benefits. All other providers should fax the request to Utilization Management at (401) (401) 274-4848 WWW. The requesting provider of the authorization can now view correspondence which have been sent via fax or mail. Percutaneous Electrical Nerve Field Stimulator System for Functional Abdominal Pain Disorders (IB-Stim) BCBSRI invites providers to join us on Tuesday, August 13 from 10-11 a. Pulse oximeters are included as part of this OTC benefit. Provider Update, May 2022 . (CMS) reminds Medicare Advantage Organizations to continue working with their contracted health care providers to review, update, and certify existing provider information in the National Plan and Provider Enumeration The information in My Health Toolkit® can help you understand your health plan benefits. After you receive the explanation of benefits (EOB), send the information with a new bill to BCBSRI for secondary payment. If a laboratory provides a laboratory service that has not been authorized, the service will More specifically, BCBSRI’s 2021 fee schedule is based on the 2020 RIMFS for the vast majority of codes/services. Providers. m. for a conference call with the Provider Relations team, who will provide updates and reminders on Flexible Benefit Card, gym membership, and other benefits The $0 BlueCHiP for Medicare Access (HMO-POS) plan offers affordable benefits. COM PUBLISHED Provider Update, A: BCBSRI covers and separately reimburses for code E0445 when billed/provided by a professional provider e. Flexible Benefit Card, gym membership, and other benefits Start here. Understanding and meeting the linguistic needs of our members is a shared concern of ^Additional Benefits are available to members who have selected a High-Value Provider as their Primary Care Provider. pdf Submit D-SNP member Effective January 1, 2025, Pelago will be available to BCBSRI members nationally. Please note from time to time it may be necessary for our Medical Director or their designee to speak to the provider Medicare approved Blue Cross & Blue Shield of Rhode Island to provide these benefits and lower copayments as part of the Value-Based Insurance Design program. Become a participating provider Use this form to add a new practice or a new provider within a practice. Overview; Shop; BCBSRI is committed to supporting primary care providers and is excited to announce additional reimbursable codes for Care Management services to ensure practices are supported in delivering these important services to members. manager, Prime Therapeutics. All Provides enhanced dental benefits for members with high-risk medical conditions like diabetes and coronary artery disease What's covered See if your dentist is in the network Effective January 1, 2025, BCBSRI will be removing the non-skilled benefit for all Medicare Advantage plans except BlueRI for Duals (D-SNP). This program lets Flexible Benefit Card, gym membership, and other (UM) criteria are available online? The formulary is a great tool to help members and providers understand what drugs Medicare Advantage See all your options, compare plans, and enroll. (CMS) reminds Medicare Advantage Organizations to continue working with their contracted healthcare providers to review, update and certify existing provider information in the National Plan and Provider Enumeration The following new policies have been created. If you use providers that are not in our network, the plan may not pay for these services. You will pay the most if you use an out-of-network provider, and you might receive a bill from a provider for the difference between the provider’s charge and what your plan pays (balance billing). Back to Provider Update violation of this policy and severe action will be taken up to and including termination from the BCBSRI provider network. • Select your primary care provider • Manage your HSA or HRA • Make a monthly premium payment Flexible Benefit Card, gym membership, and other benefits Start here. EFFECTIVE DATE: 03 |01 2025 . Overview; Shop; We have updated the credentialing form for new providers looking to become Access claims, review benefits, and connect directly with BCBSRI customer service—with one easy log-in. Dec 1, 2024. BCBSRI. If you have any additional questions about these changes or webinar registration, please contact Provider Relations at 1-844-707-5627 or ProviderRelations@bcbsri. WINFertility update. Small offices will be able to submit claims directly through bcbsri. In some instances, benefits for BlueCHiP for Medicare may be greater than what is allowed by CMS. Register or log in with your username and password to manage your account online. Step Action 1 Enter your NPI number. BCBSRI pays each service based on how the provider is paid by FFS only to participating providers. These Use provider networks, which means that you will generally have lower costs if you use doctors and hospitals within the plan's network. . If another carrier is the primary payer and a Blue plan is secondary Bill the other carrier first. Please contact the BCBSRI Provider team at (844) 707-5627 for more details regarding SmartShopper. (Apria) a DME provider with locations in East Providence, RI; Norwood, MA; and Worcester, MA, will be an out-of-network provider effective January 1, 2015. Overview; Shop; Primary care providers (PCPs) accept responsibility for arranging and coordinating the overall healthcare of BCBSRI members. Monthly Plan Premium $38 per month Value (HMO - POS) BlueCHiP for Medicare Copays for hospital benefits (401) 274-4848 WWW. If you do exceed the Stage 1 coverage limit, your benefit would enter the Stage 2 coverage gap, otherwise known as the “donut hole. other providers. walker@bcbsri. Access secure portal for key tools to check claims, eligibility, remittances, and more. Medical and Payment Policies; Each year, BCBSRI is required to participate in nationally recognized quality studies, called the Healthcare Effectiveness Data and Information Set (HEDIS®). Previously limited to four digits, this extension option allows for PROVIDER ADMINISTRATIVE MANUAL CHAPTER 2– Key Contact List for Physicians/Providers BlueLine (401) 272-1590 or 1-800-327-6712 . Please click here to join. ; February 15 - September 30, age for more information on the Point-of-Service benefit. You can email us at You may also call the BCBSRI Physician & Provider Service Center at (401) 274-4848 or 1-800-230-9050. Overview; Shop; Why choose BCBSRI? Insurance basics; Insurance through an employer? Events; Flexible Benefit Card, gym membership, and other benefits Start here. for a conference call with the Provider Relations team, who will provide important updates and There is certainly room for improvement across Rhode Island’s primary care landscape, and BCBSRI has made significant investments over the last decade to bolster and BCBSRI must follow CMS guidelines for national coverage determinations (NCDs) or local coverage determinations (LCDs). The claim will not automatically cross-over. Telemedicine ; 2024 updates; Upcoming live D-SNP training dates; Provider data reminders/attestation reminders Access claims, review benefits, and connect directly with BCBSRI customer service—with one easy log-in. benefits, call the provider call center. Required to meet annual. If a laboratory provides a laboratory service that has not been authorized, the service will Here you will have the option to become a participating provider with BCBSRI. To check on medical benefits for non-BCBSRI members, contact our Physician and Provider Service Center at (401) 274-4848 or 1-800-230-9050, Monday through Friday, 8:00 a. Methadone Maintenance. An authorization is an approval for coverage from BCBSRI. A: BCBSRI covers and separately reimburses for code E0445 when billed/provided by a professional provider e. COVERAGE . For any other provider inquiries not associated with this training, please email ClientServices@evicore. com to get Flexible Benefit Card, gym membership, and other benefits Start here. For plans with tiered networks where the Subscriber Agreement includes a process for requesting coverage of higher-tier provider services at the lower-tier benefit level, covered healthcare services from the higher-tier provider are BCBSRI invites providers to join us on Tuesday, December 12, 2023 from 11-12 p. PUBLISHED . org Provider education, responsibilities, policies and procedures Hours: Monday through Friday, 8:00 a. Refer to BCBSRI’s COT Category II Code guide, or see the PCP Quality Incentive Program booklet. Transcript. POLICY LAST REVIEWED:01 |03 2024. Coordinate with D-SNP Care Team, care plans and annual ICT Medicare Advantage See all your options, compare plans, and enroll. Routine membership, eligibility, benefit Flexible Benefit Card, gym membership, and BCBSRI requires that participating providers who treat or diagnose patients for substance use disorders or refer patients for (401) 274-4848 WWW. BCBSRI. Get (401) 274-4848 WWW. physicians and Durable Medical Equipment providers when medically necessary and ordered by a physician/provider. This feature will show any open authorizations and up to six months of approved authorizations. You shouldn’t have to Effective January 1, 2025, BCBSRI will be removing the non-skilled benefit for all Medicare Advantage plans except BlueRI for Duals (D-SNP). Box 986005 Boston, MA 02298 Boston, MA 02298 As a participating dentist with BCBSRI, you are part of the BCBSMA network, and agree to accept BCBSRI allowances when treating Provider Update, June/September 2024 Provider Update, February/July/November 2023 Provider Update, October 2021 Provider Update, November 2020 Provider Update, April 2019 REFERENCES 1. In 1993, the current Blue Cross Dental plan was created and ProviderRelations@BCBSRI. It does not describe all the parts of the plan or guarantee payment, reimbursement or eligibility of The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. The NPI and Tax ID you enter must match what’s in BCBSRI’s New: The benefit limit is $1,500 per hearing aid per occurrence. ILS Meals is one of the nation’s largest nutritional providers, delivering Medicare Advantage See all your options, compare plans, and enroll. This application is for adding new providers within a practice who are not already participating with BCBSRI, and it is used by all providers who are looking to join the network. com or call our Customer Service Department at 1-800-267-0439, October 1 - February 14, seven days a week, 8:00 a. Jul 1, 2024. Policies and coverage. Overview; Shop; Providers Home. If you Please ask your administrator or BCBSRI Provider Relations for assistance adding your provider to BCSRI. Provider Update, March 2020 . Medicare Advantage plans; Extra Help plans; Medicare Flexible Benefit Card, gym membership, and other benefits Start here. If a laboratory provides a laboratory service that has not been authorized, the service will diagnostic test of the individual’s germline will benefit the individual and one of the following criteria is met: violation of this policy and severe action will be taken up to and including termination from the BCBSRI provider network. Have $0 preventive cancer screenings. The When you see a provider in the BCBSRI network, the checkup is covered at no additional cost to you. You will pay less if you use a provider in the plan’s network. ) And if you're like 85% of BCBSRI Medicare Advantage members in 2022, you won't reach that limit, remaining in Stage 1 all year. Overview; Please note this information would not be shared outside of BCBSRI. This includes services such as durable Benefits & Coverage. Please refer to the Flexible Benefit Card, gym membership, and other benefits BCBSRI regularly reviews the list of prescription drugs we cover under our medical benefit. Paper claims. This type of coordinated care makes it easier for you to find your way through the healthcare system so you can focus on getting or staying healthy. Out-of-state: 1-800-676-2583 Flexible Benefit Card, gym All other providers should fax the request to Utilization Management at (401) 272-8885 to complete the prior authorization process. If a laboratory provides a laboratory service that has not been authorized, the service will Companies are seeking new ways to enrich their benefit offerings without overextending their budgets. BCBSRI strives to minimize provider disruption, by coordi-nating HEDIS and risk adjustment medical record requests. Overview; Already a BCBSRI Medicare Advantage member? Call your Medicare Concierge team (401) 277-2958 or 1-800-267-0439 (TTY: 711) The hospital discharge planner will help Did you know our secured Physician and Provider Portal offers the following: • Check member benefits and eligibility • View Remittance Advices (RAs) online • View claim Effective January 1, 2014, Pediatric Services including oral care has been defined as an Essential Health Benefit. ; Medicare Supplement Help cover BCBSRI is committed to improving health equity for our members and the healthcare system. Provider Update, March 2018 Understanding your benefits Provisions $1,500– annual maximum per member $0 deductible per individual plan $0 deductible per family plan Dependents covered until age 26 When you visit out-of-network Payment to the provider will be based on your plan’s reimbursement allowance, less any applicable coinsurance and/or deductible. Larger offices can continue to submit through their clearing houses. Despite those benefits, it has been identified nationally as a cause of unnecessary delays in getting care, being inefficient, and causing frustration for providers as well as patients. All other providers may fax a prior authorization request to Utilization Management at (401) 272-8885. As a result of this When you are due for recredentialing, BCBSRI will verify with CAQH that you have a current application on file. EFFECTIVE DATE: 02|05|2024. In addition to provider languages that are currently displayed, the information to be published is obtained from the provider’s entry via the voluntary disclosure on the Council for Affordable Quality HealthCare (CAQH) database. If you have any additional questions about these changes or As a reminder, you should always review member benefits and eligibility on bcbsri. BCBSRI pays each service based on how the provider is paid by FFS Medicare. Flexible Benefit Card, gym membership, and other benefits BCBSRI regularly reviews the list of prescription drugs we cover under our medical benefit. If you would like to become a BCBSRI LGBTQ Safe Zone certified practice, please contact Susan Walker, provider relations manager, at (401) 459-5381 or susan. Dental coverage: $3,000 annual benefit max + dentures, implants, crowns and so much more! • Up to 2 hearing aids for $0 + batteries • $1,500 / yr. It does not list every service that Blue Cross & Blue Shield of Rhode Island (BCBSRI) covers or list every limitation or exclusion. This will be considered a non Did you know our secured Physician and Provider Portal offers the following: • Check member benefits and eligibility • View Remittance Advices (RAs) online • View claim Sign in to your Blue Cross Blue Shield of Rhode Island account. Failing to provide direct contact information may delay the provider's enrollment Provider Directory This directory provides a list of Group BlueCHiP for Medicare’s network providers. Our Medicare Advantage See all your options, compare plans, and enroll. Contact Medicare for more information, If you are not an approved Medicaid provider and are unable to submit your claim from BCBSRI to Medicaid, you will not be allowed to bill the member for the Plan Benefits. Please see reference to the items requiring prior Provider Update, February 2025 Provider Update, June 2024 benefits, call the provider call center. Our members with behavioral health needs can benefit from a pilot program we launched with the Women’s Medicine Collaborative at Lifespan. for dental, vision and hearing services above included benefits! • $300/yr for glasses • $0 Part D Drugs** Advocacy / Support • BCBSRI Health Navigator • BCBSRI Medicaid Specialists (e. OVERVIEW . It does not describe all the parts of the plan or guarantee payment, reimbursement or eligibility of coverage. To attend the session online, please join using Microsoft Teams. Back to Provider Update. You will be notified by BCBSRI if you have missing or outdated documents. to 4:30 p. If a laboratory pr ovides a laboratory service that has not been authorized, the service will be Please refer to the appropriate Benefit Booklet to dete rmine whether the member’s plan has customized benefit coverage The purpose of this Blue Cross & Blue Shield of Rhode (BCBSRI) New Provider Credentialing Policy, herein referred to as “Policy,” Benefits and eligibility are determined by the member's subscriber agreement or member certificate and/or the employer agreement, and those documents will supersede the provisions of this medical policy. Please refer to the appropriate Benefit Booklet, Evidence of Provider Update, January 2024 Provider Update, October 2023 Provider Update, April 2022 Provider Update, May Beginning in October, providers who participate in our PCP Quality Incentive Program (PQIP) began seeing additional health equity data in their “gaps in care” reporting. Understanding and meeting the linguistic needs of our members is a shared concern of For any other provider inquiries not associated with this training, please email ClientServices@evicore. Care Team and Medicaid Benefit Coordination. Methadone maintenance. Benefits of the meal delivery program are: ILS Meals is one of the nation’s largest nutritional providers, delivering high-quality, medically tailored Flexible Benefit Card, gym membership, and BCBSRI providers can view authorizations in the MHK provider portal by expanding the drop-down and selecting “View Authorizations” on the left side of the page. If all of your required credentialing documents are current, we will access the information and process the application. We are currently beginning the pilot stage of our testing and are hoping to go live diagnostic test of the individual’s germline will benefit the individual and one of the following criteria is met: violation of this policy and severe action will be taken up to and including CMS publishes a document which indicates how an MA plan must pay out-of-network providers. to 8:00 p. For additional information, please visit: Pelago | Virtual clinic for substance use management You must receive all routine care from plan providers unless you select the BlueCHiP for Medicare Value (HMO-POS), BlueCHiP for Medicare Extra (HMO-POS), BCBSRI’s Medicare Advantage plans are the highest rated in Rhode Island– we recently received the Centers for Medicare & Medicaid Services’ (CMS’) highest Star rating You may also call the BCBSRI Physician & Provider Service Center at (401) 274-4848 or 1-800-230-9050. ; Medicare Supplement Help cover benefits tailored to the dual eligible population. Thursday, December 7, 2023 from 12-1 p. If you provide services to a member which are determined to not be medically Medicare Advantage See all your options, compare plans, and enroll. This new data indicates how members of your panel of different races and ethnicities are performing relative to various HEDIS® measures. Adding retiree benefits, like a 5-Star Medicare plan from Blue Cross & Blue Shield of Rhode Island (BCBSRI), could be the solution. Send paper CMS publishes a document which indicates how an MA plan must pay out-of-network providers. If you provide 500 EXCHANGE STREET, PROVIDENCE, RI 02903-2699 MEDICAL COVERAGE POLICY | 2 (401) 274-4848 WWW. Following the call, we will post a summary of topics covered to our Provider Conference Info page on our secure provider portal. BCBSRI is committed to improving health equity for our members and the healthcare system. com under the Medical Policy BCBSRI’s Quality Concierge Team is available to help troubleshoot any concerns you may have with opening or reading GIC reports. Centers for Medicare and Medicaid Take care of your vision with benefits like: Your choice of any frames at network retailers; The convenience of not needing to submit receipts for in-network providers; You also get significant discounts at network providers: 40% off a complete pair of prescription eyeglasses (for eyeglasses purchased after the covered pair) benefits for over 40 years. If you provide The following vaccine code will be not covered (pharmacy benefit only) for Medicare Advantage Plans, covered for Commercial Products and separately reimbursed for Professional and Facility Providers: 90593 Send the claim to BCBSRI with the primary member ID first. As a BCBSRI-contracted provider, it is your obligation to coordinate member care with contracted, in-network providers, for all BCBSRI plans and products. Box 986005 P. ; Medicare Supplement Help cover costs with a Plan 65 option. Including CPT Codes 90867, 90868 and 90869. for a conference call with the Provider Relations team, who will provide updates and reminders on the following topics:. POLICY LAST REVIEWED: 08|21|2024 . So call your primary care provider today! 2. Be aware, your network provider might use an Please contact DSNP. An introductory meeting invitation to discuss the overview of the non-skilled benefit. POLICY LAST REVIEWED:11 |20 2024. Access to care standards for all providers . If you don't have an account, you can register with your member ID and get started. 2 Doctors Online is a telemedicine service provided by American Well®, an independent company that administers Doctors Online on behalf of BCBSRI. physicians and Durable Medical Equipment providers when diagnostic test of the individual’s germline will benefit the individual and one of the following criteria is met: violation of this policy and severe action will be taken up to and including diagnostic test of the individual’s germline will benefit the individual and one of the following criteria is met: violation of this policy and severe action will be taken up to and including termination from the BCBSRI provider network. Providers may also collaborate with BCBSRI on medical records requests. If the member has a PPGRI PCP, you will be transferred to General Statement: Providers should verify benefits and eligibility via BCBSRI. for a conference call with the Provider Relations team, who will provide important updates and reminders. Local Coverage Determination (LCD): MolDX: Pigmented Lesion Assay (L38151) 2. ; Medicare Supplement Help cover costs with a Plan 65 Starting January 1, 2021, all BlueCHiP for Medicare plans include an over-the-counter (OTC) benefit program enhancement. Overview; Shop; BCBSRI Update. Claims filing Electronic claims. com. Please refer to the BCBSRI invites providers to join us on Tuesday, March 12 from 10-11 a. Please continue to use your BCBSRI payer ID when submitting electronic claims. This will be considered a non Copays for hospital benefits are based on per admission/per stay. Overview; Shop; Why choose BCBSRI? Shop plans. Benefits may Flexible Benefit Card, gym membership, and other benefits Start here Dental provider portal This site is your central resource with information like patient eligibility, claims status, and Flexible Benefit Card, gym membership, and other benefits Start here. Medicaid Enrollment / If you are a Preferred Provider Organization (PPO) member, the doctor will recognize the PPO Suitcase logo, which will ensure you will get the PPO level of benefits. You must generally use network pharmacies to fill your prescriptions. Confirm group benefit information for BCBSRI members; Review weekly remittance BCBSRI strongly encourages clinicians and provider organizations to contact the BCBSRI Provider team to verify benefits and eligibility as well as referral and authorization requirements. pdf Submit D-SNP member The following vaccine code will be not covered (pharmacy benefit only) for Medicare Advantage Plans, covered for Commercial Products and separately reimbursed for Record the member’s BlueRI for Duals and Anchor cards in your EMR to ensure the member is accessing their fullest coverage for both of their plans. Training Objectives. $4,800 annually for services you receive from in-network providers. This includes services such as durable BCBSRI invites providers to join us on Tuesday, February 13, 2024 from 10-11 a. You can find the BCBSRI Doctors Online app in your favorite app store or visit Drs-Online. Upon outreach you will receive: 1. Benefits may vary between groups/contracts. On the BCBSRI MHK Provider Portal, provider correspondence is now available under the “View Authorizations” section. Medical Benefits You can use the IVR service to search medical benefits for BCBSRI members only. g. Overview; Shop; Why choose BCBSRI? Insurance basics; Insurance through an employer? Events; (401) 274-4848 WWW. Any trip over 20 miles will count as additional trips and will be subtracted from your 24 trip total. See Effective January 1, 2025, BCBSRI will remove the non-skilled benefit for all Medicare Advantage pla P F . org if you are interested in joining the BCBSRI Non-skilled Provider Network. Medicare Advantage See all your options, compare plans, and enroll. COM Commercial products. ; Extra Help Plans Medicare + Medicaid and the new Access plans. In the pilot, primary care providers (PCPs) receive support from BCBSRI to identify and treat patients with depression, anxiety, and other mental health conditions. com under the Medical Policy heading. The SBC shows you how you and the plan would network provider? Yes. P B F. myBCBSRI gives you quick, easy access to your Flexible Benefit Card, gym membership, and other (UM) criteria are available online? The formulary is a great tool to help members and providers understand what drugs We have updated our IVR and provider portal to reflect the August 1, 2020 changes, and we encourage providers to use these tools to verify benefits. TMS Benefit is now considered a BH outpatient benefit Effective July 3, 2023, the all TMS services are now processing as an outpatient Behavioral Health benefit. January 1, 2024 updates If a provider is The following new policies have been created. pharmacies, and other providers. The new product, which is being launched in response to consumer demand, will feature access to the same high performing regional network as existing NEHP plans Flexible Benefit Card, gym membership, and other benefits Start here. Overview; Shop; BCBSRI is committed to supporting primary care providers and is excited to Take care of your vision with benefits like: Your choice of any frames at network retailers; The convenience of not needing to submit receipts for in-network providers; You also get significant Flexible Benefit Card, gym membership, and other benefits Start here. BCBSRI has seen an increase in claims processed by out-of-network providers or laboratories which were referred by a participating BCBSRI provider. Eligible providers must meet the BCBSRI provider requirements outlined in all applicable forms/policies. Overview; Shop; Primary care providers (PCPs) accept responsibility for arranging and coordinating Flexible Benefit Card, gym membership, and other benefits Start here. As a provider you are required to bill BCBSRI if you were billing Medicare, and you must accept this payment as payment in full and must not balance bill the member. Provider Update, January 2020 . Please refer to the appropriate Benefit Booklet, Evidence of Coverage, or Subscriber Agreement for applicable Medical Equipment, Medical Supplies (401) 274-4848 WWW. Centers for Medicare and Medicaid Services. Manage Your Plan; Prescription Drugs; Find Care; See Plan Perks; Live Healthy . Simply click the hyperlink of the correspondence you wish to view and the correspondence will appear in a new window. Therefore, policies for BlueCHiP for Medicare may As you know, BCBSRI’s temporary payment policy for telemedicine/telephone services is in effect until the end of this year. PARTICIPATING DENTIST ADMINISTRATIVE MANUAL 5 . When will a change to my primary care physician PCP selection be effective? Our Provider Directory also contains a listing of participating providers. We’ll explain everything you need to know about the $0 benefits that come with our BlueCHiP for Medicare (HMO-POS) plans and the extra benefits you could get if you qualify for Extra Help or Medicare + Medicaid. BCBSRI Update PBF PBF Important: verify your practice information! BCBSRI Apria Healthcare, Inc. myBCBSRI gives you quick, easy access to your digital ID cards, claims, and benefits. If you Coming soon BCBSRI will be introducing online web claim submission through bcbsri. COM EFFECTIVE DATE: 01|03|2024 POLICY LAST REVIEWED: 01|03|2024 Benefits may vary between groups/contracts. Reimbursing members. Please refer to the Providers and doctors call these Blue Cross & Blue Shield Rhode Island phone numbers for eligibility and other questions. If you have any additional questions about these changes or As a reminder, there is a functionality on the BCBSRI Provider Portal that allows providers to send inquiries via secure messaging. A PCP is a physician (MD or DO) who is board-certified or trained in internal medicine, pediatrics, or family medicine. Overview; Shop; Have your BCBSRI member ID card handy if this is your first visit. This update will change the Methadone Maintenance benefit to the following: In the BCBSRI MHK Provider Portal, providers will now have the ability to add a six-digit extension to their contact phone number. EFFECTIVE DATE: 11 |01 2024 POLICY LAST REVIEWED: 01 |03 2024. High-Value Provider network consists of Care New (401) 274-4848 WWW. You pay these amounts each benefit period until you reach the in-network or out-of-network out-of-pocket maximum. If you provide only to participating providers. Medicare copay for telemedicine correction reminder ; New vs existing patient audit ; Last live D-SNP training dates (In 2025 that drops to $2,000. Click on this link to learn more and help Flexible Benefit Card, gym membership, and other benefits Start here. We encourage you to submit any questions you would like addressed during the call to ProviderRelationsSeminars@bcbsri. com username and provide up-to-date provider information in your application. Following the call, we will post 1 Available within our service area for HMO & HMO-POS plans only/PPO plan has out-of-service benefit of 50% coinsurance/trip. If a non BCBSRI offers our Medicare Advantage members a meal delivery program through ILS Meals by Independent Living Systems. No special request or patient authorization is needed. Previously limited to four digits, this extension option allows for BlueRI for Duals Provider FAQ BlueRI For Duals, Quick Facts Link to BlueRI for Duals 2024 Flyer: BMED-962947_2024_Duals_(DSNP)_Prospect_Flier_FA2. Flexible Benefit Card, gym membership, and other benefits Start here Dental provider portal This site is your central resource with information like patient eligibility, claims status, and payments. Please refer to the appropriate Benefit Booklet, Evidence of Coverage, or Subscriber Agreement for applicable coverage for benefits/coverage. Please note if you are signing up to use the Health Trio application, you must have an active BCBSRI. Medicare Telemedicine Reminders; Upcoming live D-SNP training dates; Safe Zone Provider Deadline; Provider data reminders/attestation reminders In previous Provider Update issues, we’ve consistently reached out to our provider community to remind you of your obligation, as a Blue Cross & Blue Shield of Rhode Island (BCBSRI)-contracted provider, to coordinate members’ care with contracted, in-network providers and facilities. Questions@bcbsri. ” Upon completion of the form, your PIN will be emailed to you. Provider Claims Pre-Treatment Estimates P. vvcjkll sfxo kgjhp laxrnc obwdc qfl hox ynoou rikjv onkby