Bcbsri provider eligibility Members can connect with a behavioral health provider during their PCP visit and then continue to receive care from their PCP, or they can switch to a behavioral health provider for ongoing treatment. The training documents can be found below. The Physician & Provider Service Center can answer questions regarding a member’s benefits, including member liability for services. com or call 1-800-639-2227 or (401) 459-5000 for By addressing the root causes of unplanned hospital readmissions and emergency room visits, providers are helping to reduce healthcare costs while also ensuring quality care. Please review the full text of these policies in the Provider section of BCBSRI. View PDF. Provider Update, June 2020 . Outpatient providers will be routed to our new MHK tool in September, rather than the current “Clear Coverage” platform. BCBSRI. bcbsri. Pharmacy; Medical and Payment Policies; Claims and eligibility. for a conference call with the Provider Relations team, who will provide updates and reminders on the following topics:. Let us know what you think. com (see below). 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. For any other provider inquiries not associated with this training, please email ClientServices@evicore. HIPAA transactions; How to file a claim; Secure portal; Provider Update; Forms; BCBSRI Update. At Blue Cross & Blue Shield of Rhode Island (BCBSRI), our mission is to improve members’ health and peace of mind by facilitating their access to affordable, high-quality healthcare. Manage Your Plan; Prescription Drugs; Find Care; See Plan Perks; Live Healthy As long as you have access to the bcbsri. 500 exchange street, providence, ri 02903-2699 medical coverage policy | 1 (401) 274-4848 www. Medicare copay for telemedicine correction reminder ; New vs existing patient audit ; Last live D-SNP training dates When you are due for recredentialing, BCBSRI will verify with CAQH that you have a current application on file. to 8:00 p. Providers are tiered and can find their tier status by using the BCBSRI Provider Finder. 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. BCBSRI has updated our Hospital Readmission Payment policy for readmissions to an acute general short-term hospital. Provider Update, July 2023 . BCBSRI/designee shall have the right to review any Why choose BCBSRI? Network coverage; Pharmacy & prescriptions; What's included in all plans; Claims and eligibility. com . It only takes a couple of minutes and will help us improve our service. Secure messaging is located on the left-hand tool bar once you log in to bcbsri. Requests for DME should be obtained via the BCBSRI online prior authorization tool, which is available only to participating providers. org or reach us by phone at (401) 459-1005 if you have any questions about our PCP Quality Incentive Program (PQIP), Gap in Care Reports, or any other quality Medicare Advantage See all your options, compare plans, and enroll. It does not describe all the parts of the plan or guarantee payment, reimbursement or eligibility of coverage. See what's covered by your health plan. Back to Provider Update What information are you looking for? BCBSRI Provider Directory unless BCBSRI receives notification from the provider to be excluded from the 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. Eligibility. Claims filing Electronic claims. Gus Manocchia, M. org BCBSRI Provider Portal: Use the Eligibility Search by Member ID in the Patient Eligibility section of the secure portal. Medicare Advantage See all your options, compare plans, and enroll. for a conference call with the Provider Relations team, who will provide updates and reminders on important topics and changes for 2025. Please note that as a participating provider, it is your responsibility to notify members about non-covered services prior to rendering them. Members are actively supported by a BCBSRI Medicaid Specialist in effort to regain Medicaid. As a reminder, there is a functionality on the BCBSRI Provider Portal that allows providers to send inquiries via secure messaging. org for assistance. Mail: Blue Cross & Blue Shield of Rhode Island. Using secure messaging, you can ask questions about: Eligibility/prior authorization/benefits – For Rhode Island members only Self-guided Study: Complete the 2025 Provider Attestation form CMS Annual Requirement for ALL providers, cannot be delegated. Paper claims. Centers for Medicare and Medicaid Procedure codes in the range 10000-69999 having a Medicare Physician Fee Schedule (MPFS) bilateral indicator ‘1’, designating the code is eligible to be billed on both sides of the body, must be billed with the appropriate anatomical modifier. Questions@bcbsri. Will BCBSRI support Medicaid recertification? If a member loses eligibility, BCBSRI grants them a 90-day grace period. Soon we will begin publishing that provider data in our Find a Doctor provider directory on bcbsri. They are unbelievably helpful! High-Value Providers (HVP) are PCP groups with patient-centered and innovative care models that BCBSRI provider agreement. HIPAA transactions; How to file a claim; Secure portal; Provider Update; Please note this information would not be shared outside of BCBSRI. But awareness of this disease – which is the third most common cancer, and third most common cause of cancer-related death in the U. All other providers may fax a prior authorization request to Utilization Management at (401) 272-8885. 4. Electronic inquiry: Submit a HIPAA 270 transaction (eligibility) to BCBSRI. com. Primary care providers (PCPs) accept responsibility for arranging and coordinating the overall healthcare of BCBSRI members. Failing to provide direct contact information may delay the provider's enrollment request. As a result of these reviews, providers may be asked for medical records and billing documents that support the charges billed. Aug 1, 2019. BCBSRI offers multiple training modalities and sessions for providers to meet these requirements. This medical policy is made available to you for informational purposes only. BCBSRI pays each service based on how the provider is paid by FFS Medicare. As part of our commitment, we aim to increase availability of care to the LGBTQ+ community, which remains an underserved population with specific healthcare needs. Below is a quick overview about how this plan effects providers: All providers participating in the Blue network are included in Lifespan’s coverage. A number of other enhancements will take place and will be communi-cated at a future date. If all of your required credentialing documents are current, we will access the information and process the application. All other providers should fax the request to Utilization Dental provider portal This site is your central resource with information like patient eligibility, claims status, and payments. com, in addition to the languages spoken, which are displayed today. Dear Provider, Blue Cross & Blue Shield of Rhode Island (BCBSRI) is committed to improving the health of our members and all Rhode Islanders, by supporting access to high-quality, cost-effective healthcare. FEP is transitioned in a phased rollout, so not all members card will be distributed for 1/1/24. HIPAA transactions; How to file a claim; Secure portal; Provider Update; Forms; 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. com under the Medical Policy heading. Mental health counselors and marriage and family therapists will be allowed to render services to Medicare members. Provider Relations (401) 274-4848 or 1-800-230-9050 Fax: (401) 459-5531 Physician/provider education, responsibilities, and policies and procedures The information below is effective as of October 1, 2024, and applies to all commercial BCBSRI products, including all Large Group and Small Group markets. Not all members will receive their redetermination at the same time; the state has 14 months - or until May 31, 2024 - to complete all Medicaid redeterminations. Access provider publications including: Participating Provider Administrative Manual; BCBSRI Practice Guidelines; Orientation visits. The Centers for Medicare and Medicaid Services (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 System (NPPES). Provider Update, July/August 2022. HIPAA transactions; How to file a claim; Secure portal; Blue Cross & Blue Shield of Rhode Island (BCBSRI) regularly reviews the list of prescription drugs we cover under our medical benefit. com account. 3. ; February 15 - September 30, BCBSRI has updated our Hospital Readmission Payment policy for readmissions to an acute general short-term hospital. Printed Materials and Plan Specifics: ProviderRelations@bcbsri. , BCBSRI senior vice president and chief medical officer. Beginning January 1, 2025, 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 Beginning January 1, 2025, 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 In the BCBSRI MHK Provider Portal, providers will now have the ability to add a six-digit extension to their contact phone number. We encourage you to submit any questions you would like addressed during the call related to the topics above, or to other topics, to If you have any questions regarding how a member is set up in our system, please review the members eligibility on our provider portal on bcbsri. 277CA – Unsolicited claims status reports. O. Check status of all claims submitted with your National Provider Identifier (NPI). The requesting provider of the authorization can now view correspondence which have been sent via fax or mail. ; Medicare Supplement Help cover costs with a Plan 65 option. CMS requires participating providers to complete an annual D-SNP, or dual special needs plan, Model of Care training. See www. They can also assist if you’re simply looking for a participating behavioral health provider. This includes services such as durable Provider Directory This directory provides a list of Group BlueCHiP for Medicare’s network providers. Attention: Medical Policy, CPT Review. For providers who require assistance with the Health Trio application, you may contact our Provider Relations team at ProviderRelations@bcbsri. BCBSRI will continually review NCD and LCD updates and implement appropriate policy changes. com or call our Customer Service Department at 1-800-267-0439, October 1 - February 14, seven days a week, 8:00 a. Welcome to the 2024 PCP Quality Incentive Program (PQIP) measurement year! We are excited to continue to strive for excellence with our provider partners across the network. Colorectal Cancer Awareness Month is observed every March. edi. 500 Exchange Street. Providers must give BCBSRI a 60-day notification of any provider or practice changes. All other providers should fax the request to Utilization Management at (401) Primary care providers (PCPs) accept responsibility for arranging and coordinating the overall healthcare of members. How can providers help? Medicare Advantage See all your options, compare plans, and enroll. You will be notified by BCBSRI if you have missing or outdated documents. All Medicare Advantage plans, BlueCHiP Direct, BlueCHiP Direct Advance, BlueCHiP w/Flex, Network Blue New England, Network Blue New England Options, and Blue Choice New England products will not require a referral for physical and Here you will have the option to become a participating provider with BCBSRI. REFERENCES . Watch and learn about these $0 plans. Use the Find a Doctor tool if your vision exam is covered under your medical plan. The 2023 PQIP booklet and future updates can be found on the BCBSRI Provider Portal under Quality > Primary care providers (PCPs) accept responsibility for arranging and coordinating the overall healthcare of BCBSRI members. Or you may email ProviderRelations@bcbsri. You can verify BlueCHiP Direct Advance members by validating the prefix code ZBE on the member identification card. Therefore, we would like to inform you that there is a new language resource available to you on the BCBSRI provider portal. org Personalized Trainings: ProviderRelations@bcbsri. Provider Update, December 2019 . If you have any additional questions about these changes or webinar registration, please contact Provider Relations at 1-844-707-5627 or ProviderRelations@bcbsri. BCBSRI has collaborated with providers throughout Rhode Island to ensure that our members have access to urgent appointments for behavioral health needs, such as outpatient therapy and medication management. for a conference call with the Provider Relations team, who will provide important updates and reminders. m. At this time BCBSRI does not require non-skilled home care agencies to be Medicare certified. BCBSRI invites providers to join us on Tuesday, November 14, 2023 from 10-11 a. HIPAA transactions; How to file a claim; Secure portal; Provider Update; Forms; Provider Credentialing and Recredentialing Process Upload date. BCBSRI’s PQIP booklet contains acceptable codes for each of the PQIP measures. com by following these easy steps: 1. These providers have dedicated time slots available exclusively for BCBSRI members. Call us if you’d like an orientation at your office about provider publications or: Self-guided Study: Complete the 2025 Provider Attestation form CMS Annual Requirement for ALL providers, cannot be delegated. The Centers for Medicare and Medicaid Services (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 System (NPPES). Did you know you can look up a CPT Codes by the search bar on the top right hand Provider Update, February/October 2024 . Providers may: As a reminder, you are required as a participating provider in the D-SNP network to complete the annual D-SNP training by March 31, 2025. Following the alphabetical list are listings by location and specialty, and by the type of provider. In the absence of an applicable NCD, LCD, or other CMS-published guidance, BCBSRI will apply policy determinations developed using peer-reviewed scientific evidence. This will allow BCBSRI to establish a provider in our system to support claims adjudication and demonstrate compliance with the BCBSRI administrative policies: • Signed current BCBSRI Participating Provider Agreement ** • W-9 Form ** • Type II NPI Form As an in-network provider with the BlueRI for Duals (HMO-D-SNP) network, you are required to take an initial training that is due by March 31, 2025 and annual refresher training on a yearly basis. All other providers should fax the request to Utilization For additional information or to find a Headway provider, please visit: Headway | Find Therapists Covered by Your Insurance or contact BCBSRI Behavioral Health Care Management by phone at 1-800-274-2958 or triage_group@bcbsri. Local Coverage Determination (LCD): MolDX: Pigmented Lesion Assay (L38151) 2. Effective January 1, 2025, BCBSRI will move from facility contracting and billing and will start credentialing licensed chemical dependency professionals (LCDPs) individually. Failing to provide direct contact information may delay the provider's Requests for authorization of genetic testing should be submitted via the BCBSRI online prior authorization tool, which is available to BCBSRI-participating providers. ) who is board-certified or trained in internal medicine, pediatrics, or family medicine. Their FEP ID will not change. An important component of our commitment is our continued efforts to reward primary care providers (PCPs) for improving quality and closing Why choose BCBSRI? Network coverage; Pharmacy & prescriptions; What's included in all plans; Your Blue Store; Claims and eligibility. Following the Effective January 1, 2020, BCBSRI will become the insurer for all Lifespan employees. Close. (401) 274-4848 WWW. Let’s see what benefits you might be able to get. org Personalized Trainings: Kathleen. This new data indicates how members of your panel of different races and ethnicities are performing relative to various HEDIS® measures. Access to care standards for all providers . i. Members are able to elect into this program if they are actively enrolled in a Medicare Part D plan. HIPAA transactions; How to file a claim; Secure portal Contacts; FAQ; Provider Relations. On the BCBSRI MHK Provider Portal, provider correspondence is now available under the “View Authorizations” section. Send paper claims to: Dental Claims Administrator P. A PCP is a physician (MD or DO Accordingly, the Rhode Island Department of Human Services (DHS) will be resuming eligibility redeterminations for Medicaid members on April 1, 2023. For information on member-specific BCBSRI Provider Directory unless BCBSRI receives notification from the provider to be excluded from the 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. 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. BCBSRI will require that all LCDPs are individually credentialing by February 1, 2025. All plans offer this payment option and participation is voluntary. BCBSRI. This plan offers the freedom to choose the providers and pharmacists the patient wants to see. Any retrospective home healthcare delivered prior to January 1, 2024 can be faxed into BCBSRI’s utilization management team at (401) 459-1623 or to Prospect’s utilization management team at 1-844-762-9230. During this year’s Medicare Annual Election Period (AEP), Blue Cross & Blue Shield of Rhode Island (BCBSRI) is offering our first Medicare Advantage (MA) PPO plan. 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. Box 69427 Harrisburg, PA 17106 (401) 274-4848 WWW. Please continue to use your BCBSRI payer ID when submitting electronic claims. BCBSRI’s Quality Concierge Team is available to help troubleshoot any concerns you may have with opening or reading GIC reports. It Submit and check the status of your claims. The demographics submitted in the provider portal need to match our records exactly to locate the member for any requests for authorizations. P B F. Nov 1, 2023. Jul 1, 2024. Telemedicine ; 2024 updates; Upcoming live D-SNP training dates; Provider data reminders/attestation reminders The following new policies were created and will be effective January 1, 2024. COM MEDICAL COVERAGE POLICY | 1 OVERVIEW The intent of this policy is to provide information regarding credentialing for outpatient professional behavioral health providers, document provider specialty restrictions for CPT codes, and provide medical record documentation requirements for Behavioral Health Providers. The race and ethnicity data we’ll publish has been provided by providers themselves, when voluntarily disclosed on the Council for Affordable Quality HealthCare (CAQH) database. FEP members will begin to receive new cards. The Health Trio help desk is reserved for issues BCBSRI invites providers to join us on Tuesday, December 12, 2023 from 11-12 p. Become a participating provider Use this form to add a new practice or a new provider within a Claims and eligibility. “This is just the first step BCBSRI is taking to improve the experience for providers and their staff. The new plan is the HealthMate for Medicare PPO plan (HealthMate). A PCP is a physician (M. org. BCBSRI claims department has seen an increase in claims rejecting for no eligibility because claims P B F . org if you are interested in joining the BCBSRI Non-skilled Provider Network. Medicare Telemedicine Reminders; Upcoming live D-SNP training dates; Safe Zone Provider Deadline; Provider data reminders/attestation reminders The information in My Health Toolkit® can help you understand your health plan benefits. NEHP tiered network . Following the call, we will post Each year, BCBSRI is required to participate in nationally recognized quality studies, called the Healthcare Effectiveness Data and Information Set (HEDIS®). Check patient The information in My Health Toolkit® can help you understand your health plan benefits. Find an eye doctor. This Medicare Prescription Payment Plan fact sheet has helpful information about the program and will be sent to all BCBSRI Medicare Part D members. Providers may: In the absence of an applicable NCD, LCD, or other CMS-published guidance, BCBSRI will apply policy determinations developed using peer-reviewed scientific evidence. Please note this information would not be shared outside of BCBSRI. network as existing NEHP plans and PROVIDER ADMINISTRATIVE MANUAL CHAPTER 2– Key Contact List for Physicians/Providers BlueLine (401) 272-1590 or 1-800-327-6712 . Biomarker Testing Mandate; Blood Product Molecular Antigen Typing Requests for authorization of genetic testing should be submitted via the BCBSRI online prior authorization tool, which is available to BCBSRI-participating providers. Policy@bcbsri. This will allow BCBSRI to establish a provider in our system to support claims adjudication and demonstrate compliance with the BCBSRI administrative policies: • Signed current BCBSRI Participating Provider Agreement ** • W-9 Form ** • Type II NPI Form Medical Procedures are considered medically necessary when the criteria in the BCBSRI online prior authorization tool has been met. If you have any questions regarding how a member is set up in our system, please review the members eligibility on our provider portal on bcbsri. ) who transmits to or receives electronic data from BCBSRI. Professional outpatient providers who are credentialed with BCBSRI will only be required to have a written policy addressing the Supervisory Protocol requirements. Log on to the provider portal of BCBSRI. Click on Forms. This will allow BCBSRI to establish a provider in our system to support claims adjudication and demonstrate compliance with the BCBSRI administrative policies: • Signed current BCBSRI Participating Provider Agreement ** • W-9 Form ** • Type II NPI Form BCBSRI is committed to improving health equity for our members and the healthcare system. Routine membership, eligibility, benefit information, and claims status for all BCBSRI 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 to confirm member coverage prior to rendering services. BCBSRI always goes above and beyond to make sure I'm receiving the best healthcare possible. Provider Update, July 2021. The Safe Zone program has grown to include adult and pediatric primary care, behavioral health, oral health, assisted living for older adults, child and family services, and organizations Email: Medical. Upon outreach you will receive: 1. com provider portal, you will be all set! If you do not have access to the provider portal, please contact Provider Relations at ProviderRelations@bcbsri. You can also use the Find a Doctor tool at bcbsri. According to the American Association of Medical Colleges (AAMC), more than 40% of active physicians will be 65 or older within the next 10 years, and by 2034 it’s estimated that the national PCP deficit will be somewhere between 17,800 BCBSRI invites providers to join us on Tuesday, December 10, 2024 from 10-11 a. In order to become a participating provider, the following documents are required. After completing the training, you are to complete the D-SNP Provider Attestation Form below. Effective for dates of service on December 1, 2020 through December 31, 2020 BCBSRI will be suspending prior authorization requirements for Medicare Advantage products for Effective January 1, 2024, FEP will follow CMS guidelines regarding eligibility for the FEP Medicare Prescription Drug Program (MPDP). Namely, there’s a nationwide shortage of primary care providers, with more providers leaving the field than entering it. You can email us at QualityHEDIS@bcbsri. Movement of Telemedicine cost sharing to match office cost share A BCBSRI EDI trading partner is any business partner (provider, billing service, software vendor, employer group, financial institution, etc. Please take a moment to review your practice information in our Find a Doctor tool, focusing on the following areas: Panel status refers to whether or not you are accepting new patients, which applies to specialists as well as PCPs. If you have any additional questions after reviewing the information, please contact our Our EDI team can be reached via email at hipaa. You can contact the Physician & Provider Service Center at (401) 274-4848 or 1-800-230-9050. This policy is applicable to facilities reimbursed based on a contracted diagnosis-related group (DRG) or case rate methodology. Jun 1, 2021. com 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. Updates from Provider Relations Review Claims Status Check Member Benefits & Eligibility Review Your Weekly Remittance Attest to Provider Data Quarterly Secure Messaging to Provider Call Center As always, we ask that you verify BCBSRI member benefits and eligibility by logging on to the secure provider portal of bcbsri. All Medicare Advantage plans, BlueCHiP Direct, BlueCHiP Direct Advance, BlueCHiP w/Flex, Network Blue New England, Network Blue New England Options, and Blue Choice New England products will not require a referral for physical and 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 copay/coinsurance. Acupuncture benefits vary across all Medicare plans. 2. Two proposed programs are already up and Check patient eligibility to verify effective dates of coverage, copays, deductibles, and other information. – is something Blue Cross & Blue Shield of Rhode Island (BCBSRI) has made a priority all year long, since it’s one of the few cancers with a reliable detection method even in its Participating with BCBSRI 2 Once you become a participating (in network) Doula provider with BCBSRI, you will be able to gain access to the Provider Portal. For information call the BCBSRI Provider Call Center, at (401) 274-4848. Overview; Policies and coverage. specific For information on member Please note that only your office administrator can add providers to your BCBSRI. support@bcbsri. CMS publishes a document which indicates how an MA plan must pay out-of-network providers. Patient benefit and eligibility information, referral questions, and claims inquiries specific to FEP members. Hours: Monday through Friday, 8:00 a. Simon@bcbsri. Our goal is to make sure that our members continue to have access to effective medications at the lowest possible cost. All other providers should fax the request to Utilization Medicare Advantage See all your options, compare plans, and enroll. BCBSRI has seen an increase in claims processed by out-of-network providers or laboratories which were referred by a participating BCBSRI provider. Effective July 2024, BCBSRI began performing additional prepayment claim reviews using Optum’s Comprehensive Payment Integrity (CPI) tool, which ensures that claims are processed and paid accurately. If you have Blue Cross Vision, use this option for routine eye exams, glasses, and contacts. Health Trio reminder . These reports are generated for all 837 transmissions and are very generic in nature. Find a a network provider? Yes. The information below is effective as of April 1, 2024 and applies to all commercial BCBSRI products, including all Large Group and Small Group markets. COM. As we head into 2024, please reach out to the BCBSRI Quality Concierge Team to ensure you are equipped with the latest PCP Quality Incentive Program (PQIP) booklet and BCBSRI has updated our Hospital Readmission Payment policy for readmissions to an acute general short-term hospital. Centers for Medicare and Medicaid Services. ; Extra Help Plans Medicare + Medicaid and the new Access plans. manager, Prime Therapeutics. BCBSRI invites providers to join us on Tuesday, February 13, 2024 from 10-11 a. . Jan 18, 2023. com Claims and eligibility. Any errors on these reports are either Provider or member related. Navigation. Click on Case Management As in past years, BCBSRI is updating its allowable amounts/rates for common evaluation and management (E&M) services for primary care providers (PCP), as well as specialist providers. To help providers with completing the training, we are offering multiple sessions for providers to join Medicare Advantage See all your options, compare plans, and enroll. You may also use our automated referral form at BCBSRI. to 4:30 p. Not applicable . Other updates BCBSRI has also made other rate adjustments in its fee schedule, both upward and downward, generally following Medicare changes and continuing BCBSRI invites providers to join us on Tuesday, March 12 from 10-11 a. Click the below link to explore our formularies and UM criteria: Please note from time to time it may be necessary for our Medical Director or their designee to speak to the provider directly. All other providers should fax the request to Utilization As a reminder, it is important for all acupuncture providers to check member eligibility and benefits when the new year approaches as some members may change their plans. Simply click the hyperlink of the correspondence you wish to view and the correspondence will appear in a new window. Please contact DSNP. Previously limited to four digits, this extension option allows for more accurate contact information, making communication with our UM team easier for those who have extensions more than four digits long. Please ask your administrator or BCBSRI Provider Relations for assistance adding your provider to BCSRI. Please refer to your policy for specific benefits. As a reminder, there is a functionality on the BCBSRI Provider Portal that allows providers to send P B F . The codes included in this booklet are the most commonly used, but are not exhaustive. Dental Providers: The filing limit for claim submission for services to Blue Cross Blue Shield of Rhode Island 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 The provider should make every effort to resolve billing and/or coding inquiries directly with BCBSRI/designee. Requests for medical procedures should be obtained via the BCBSRI online prior authorization tool, which is available only to participating providers. May 16, 2024. org prior to the meeting. As a BCBSRI-contracted provider, it is your obligation to coordinate member care with contracted, in-network providers, for all BCBSRI plans and products. HIPAA transactions; How to file a claim; Secure portal; Provider Update; Forms; Dec 1, 2023. Any member’s eligibility and demographic details can be verified in the Patient Eligibility section on bcbsri. As of January 1, 2024, home care agencies will no longer have to use the MHK provider portal to submit requests. BCBSRI invites our participating providers to join us on Tuesday, November 12 from 10-11 am. BCBSRI is taking an additional step to support its members during the COVID-19 crisis. This two-step requirement includes review of course content and attestation of your review. These performance measures are used by the National Committee for Quality Assurance (NCQA), the Center for Medicare and Medicaid Services (CMS), and the Rhode Island Department of How do you find BlueCHiP for Medicare’s providers in your area? You may look up a provider by last name in the alphabetical physician/provider listing starting on Page 1 of this directory. Beginning February 5, 2024, BCBSRI will no longer require a Notice of Admission for the following services: Intensive Outpatient (mental health and/or substance use disorder) Child and Family Intensive Treatment (CFIT) Applied Behavior Analysis (ABA) Effective November 1, 2024 BCBSRI will no longer require credentialed providers to submit documentation for approval to implement a supervisory protocol. For drug specific prior authorization details, please refer to the drug criteria in the Updated access to care standards for PCP’s and behavioral health providers Primary care providers (PCPs) accept responsibility for arranging and coordinating members’ overall healthcare. The NPI and Tax ID you enter must match what’s in BCBSRI’s system. If you provider is listed on BCBSRI but not appearing in your To refer a patient to the BCBSRI BH Case Management program, please call 1-800-274-2958 or email triage_group@bcbsri. Providers. 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. Providence, Rhode Island 02903. These changes do not apply to the Blue CHiP for Medicare programs. 9. Members can opt in to this program if they are actively enrolled in a Medicare Part D plan. We will soon begin publishing provider race and ethnicity in our Find a Doctor provider directory on bcbsri. Durable medical equipment is considered medically necessary when the criteria in the BCBSRI online authorization tool has been met. HIPAA transactions; How to file a claim; Secure portal; Provider Update will be covered and separately reimbursed for Professional and Facility providers for Medicare Advantage Plans and Commercial Products: 49186, 49187 If you have any questions about changes to the behavioral health fee schedules, please contact Provider Relations at 1-844-707-5627 or email ProviderRelations@bcbsri. The majority of BlueCard electronic inquiries are answered within 48-72 hours (Monday through Friday during regular office hours). Click on Tools and Resources. An introductory meeting invitation to discuss the overview of the non-skilled benefit. Telemedicine ; 2024 Updates; Upcoming live D-SNP training dates; Provider data; We encourage you to submit any questions you would like addressed 2022 saw a significant increase in the number of BCBSRI-certified Safe Zone providers offering safe, affirming, and inclusive care to the LGBTQ+ community. Check claims status and patient eligibility, view remittances, and review the Provider Administrative Manual. If you have any questions regarding this change, please contact ProviderRelations@bcbsri. A PCP is a physician (MD or DO) who is board-certified or trained in internal medicine, pediatrics, or family medicine. D. Claims and eligibility. We encourage you to submit any questions you would like addressed during the call to ProviderRelationsSeminars@bcbsri. effective date: 11 |01 2024 policy last reviewed: How do you find BlueCHiP for Medicare providers in your area? You may look up a provider by last name in the alphabetical physician/provider listing starting on Page 1 of this directory. If requested, the provider will submit to BCBSRI/designee a final itemized claim, and/or records within sixty (60) calendar days of request. As part of our ongoing efforts to make high-quality and affordable healthcare available to our members, BCBSRI regularly reviews the list of prescription drugs we cover on the commercial formularies. ” The Physician & Provider Service Center transition will be complete in Medicare Advantage See all your options, compare plans, and enroll. Medical Procedures are considered medically necessary when the criteria in the BCBSRI online prior authorization tool has been met. If you have any additional questions after reviewing the information, please contact our Provider & Physician Call Center at (401) 274-4848. In order to register as a BCBSRI Trading Partner and begin testing, it is necessary to complete the Trading Partner Registration (TPR) form. Did you know our secured Physician and Provider Portal offers the following: • Check member benefits and eligibility • View Remittance Advices (RAs) online • View claim status • Submit preauthorization requests through MHK • Send secure messages to our Physician & Provider Call Center team instead of calling Do you feel your office needs a better experience Mental health counselors and marriage and family therapists will be allowed to render services to Medicare members. org The formulary is a great tool to help members and providers understand what drugs the plan covers; which of these drugs have UM edits, such as prior authorization, quantity limit, and/or step therapy; and which drugs in the same therapeutic category do not have UM. Medical Policies Lookup on bcbsri. or D. S. Check member eligibility for BCBSRI members; Confirm group benefit information for BCBSRI invites providers to join us on Tuesday, August 13 from 10-11 a. HIPAA transactions; How to file a claim BCBSRI Update. Understanding and meeting the linguistic needs of our members is a shared concern of BCBSRI and our contracted providers. raofcz wwdkr mhulq uzaapd vhgjr bwl jslf nfwbpt zdzww syam