Bcbsri provider eligibility. Mail: Blue Cross & Blue Shield of Rhode Island.

Bcbsri provider eligibility Manage Your Plan; Prescription Drugs; Find Care; See Plan Perks; Live Healthy Depending on your plan, you may need a referral from your primary care provider (PCP) before seeing a specialist or getting a test or procedure. Please note this information would not be shared outside of BCBSRI. Let us know what you think. Please contact our Customer Service number at 1-800-267-0439 (TTY/TDD users should call 711). Enrollment in Blue Cross & Blue Shield of Rhode Island depends on contract renewal. Access provider publications including: Participating Provider Administrative Manual; BCBSRI Practice Guidelines; Orientation visits Blue Cross & Blue Shield of Rhode Island is an independent licensee of the Blue Cross and Blue Shield Association. Practitioner Change Forms are located on bcbsri. You must provide 60 days notice to BCBSRI when a provider is no longer going to be practicing for your group. Nov 1, 2024 · 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. org. 500 exchange street, providence, ri 02903-2699 medical coverage policy | 3 (401) 274-4848 www. 500 EXCHANGE STREET, PROVIDENCE, RI 02903 -2699 MEDICAL COVERAGE POLICY | 2 (401) 274-4848 WWW. Nov 1, 2023 · BCBSRI’s PQIP booklet contains acceptable codes for each of the PQIP measures. Printed Materials and Plan Specifics: ProviderRelations@bcbsri. EFFECTIVE DATE: 01 |01 2025 . The codes included in this booklet are the most commonly used, but are not exhaustive. Nov 1, 2024 · BCBSRI invites our participating providers to join us on Tuesday, November 12 from 10-11 am. ” The Physician & Provider Service Center transition will be complete in (401) 274-4848 WWW. Check status of all claims submitted with your National Provider Identifier (NPI). Out-of-state: 1-800-676-2583. Blue Cross & Blue Shield of Rhode Island is an HMO plan with a Medicare contract. Brokers Blue Cross & Blue Shield of Rhode Island is an independent licensee of the Blue Cross and Blue Shield Providers and doctors call these Blue Cross & Blue Shield Rhode Island phone numbers for eligibility and other questions. Don’t see your provider on the BCBSRI portal? Please note that only your office administrator can add providers to your BCBSRI. Services such as dental Routine membership, eligibility, benefit information, and claims status for all Blue Cross & Blue Shield of Rhode Island members Hours: 24 hours a day, seven days a week Download instructions on how to use BlueLine. Below is a quick overview about how this plan effects providers: All providers participating in the Blue network are included in Lifespan’s coverage. Dec 1, 2019 · Effective January 1, 2020, BCBSRI will become the insurer for all Lifespan employees. BCBSRI. Select how many miles away the provider may be from the above zip code: Within zip code 5 10 15 25 30 Languages Nov 1, 2024 · 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 Disorder Patient Records Rule (42 CFR. Secure messaging is located on the left-hand tool bar once you log in to bcbsri. m. Out-of-State Plans. Claims and eligibility. effective date: 01|01|2018 policy last updated: Blue Cross & Blue Shield of Rhode Island 500 Exchange Street Providence, RI 02903 Local: (401) 459-1000 Outside Rhode Island: 1-800-637-3718 What information are you looking for? Dec 1, 2024 · BCBSRI invites providers to join us on Tuesday, December 10, 2024 from 10-11 a. Self-guided Study: Complete the 2025 Provider Attestation form CMS Annual Requirement for ALL providers, cannot be delegated. Check patient eligibility to verify effective dates of coverage, copays, deductibles, and other information. All trademarks unless otherwise noted are the property of Blue Cross & Blue Shield of Rhode Island or the Blue Cross and Blue Shield Association. The majority of BlueCard electronic inquiries are answered within 48-72 hours (Monday through Friday during regular office hours). Providence, Rhode Island 02903. ; Medicare Supplement Help cover costs with a Plan 65 option. D-SNP FAQ; BCBSRI 2025 DSNP Training; Training Attestation Blue Cross & Blue Shield of Rhode Island . Please note from time to time it may be necessary for our Medical Director or their designee to speak to the provider directly. X. com 3 days ago · Medicare Advantage See all your options, compare plans, and enroll. In compliance with Rhode Island law, if you wish to end your participation with BCBSRI as a result of the updated fee schedules, you may notify BCBSRI of your intent to terminate your Participating Physician/Provider Agreement within sixty (60) days of receipt of this notification. (401) 274-4848 WWW. for a conference call with the Provider Relations team, who will provide important updates and reminders. Start here. All PCP visits (including sick visits) will now have a $0 copay for dates of services on or after January 1, 2025. It does not describe all the parts of the plan or guarantee payment, reimbursement or eligibility of coverage. Jul 1, 2023 · As a reminder, there is a functionality on the BCBSRI Provider Portal that allows providers to send inquiries via secure messaging. Using secure messaging, you can ask questions about: Eligibility/prior authorization/benefits – For Rhode Island members only In order to become a participating provider, the following documents are required. Policy@bcbsri. Any member’s eligibility and demographic details can be verified in the Patient Eligibility section on bcbsri. Providers; Individuals & Families. It’s important to think about where you typically receive care. Dec 1, 2024 · The Medicare Prescription Payment Plan is a new payment option in the prescription drug law that works with Medicare Part D beneficiaries’ current drug coverage to help them manage their out-of-pocket Medicare Part D drug costs by spreading them across the calendar year (January-December). org Personalized Trainings: ProviderRelations@bcbsri. bcbsri. BCBSRI use of Provider Performance Data for Healthcare Operations Blue Cross & Blue Shield of Rhode Island is an independent licensee (401) 274-4848 WWW. Overview; Blue Cross & Blue Shield of Rhode Island is an independent licensee of the Blue Cross and Blue Shield Association Nov 1, 2024 · Primary care providers (PCPs) accept responsibility for arranging and coordinating the overall healthcare of BCBSRI members. com) 20. September 22, 2016 . Attention: Medical Policy, CPT Review. Tiering of ASC/OP hospital cost sharing Nov 18, 2024 · Claims and eligibility. com (see below). Dec 5, 2023 · Effective February 1, 2024, Blue Cross/Blue Shield of Rhode Island (BCBSRI) prior authorization requests for radiology and cardiology procedures will be initiated through eviCore healthcare (CareCorenational portal) for dates of service February 1, 2024 and beyond, as outlined below. This policy is applicable to facilities reimbursed based on a contracted diagnosis-related group (DRG) or case rate methodology. org Personalized Trainings: Kathleen. Attention: Medical Policy, CPT review Please note that as a participating provider, it is If you already have dental coverage with BCBSRI, you can find everything you need to know about your plan, including covered services and claims, through the Dental Benefits section of your online account. Blue Cross & Blue Shield of Rhode Island is an independent licensee of the Blue Cross and Blue Shield Association. Oct 1, 2024 · Medicare Advantage See all your options, compare plans, and enroll. ; Extra Help Plans Medicare + Medicaid and the new Access plans. Providers. COM. Search for providers. Blue Cross & Blue Shield of Dec 1, 2024 · Medicare Advantage See all your options, compare plans, and enroll. If you have any questions regarding this training, please contact providerrelations@bcbsri. There are several advantages to getting referrals: There are some services that never require a referral—including mental health and substance abuse treatment, emergency care, and OB/GYN services. So finding a network of doctors and hospitals that fits your needs is a smart first step in choosing a health plan. Simon@bcbsri. All other providers may fax a prior authorization request to Utilization Management at (401) 272-8885. A PCP is a physician (MD or DO) who is board-certified or trained in internal medicine, pediatrics, or family medicine. Providers are tiered and can find their tier status by using the BCBSRI Provider Finder. Some of the providers or organizations listed are not contracted providers with BCBSRI or may not participate in one or more of BCBSRI’s networks. . If you are not sure who your Provider Relations representative is you can reach out to Provider. Do you get most of it near home, or do you need access to care across the country? Direct local network 3 days ago · All trademarks unless otherwise noted are the property of Blue Cross & Blue Shield of Rhode Island or the Blue Cross and Blue Shield Association. Out-of-State Plans 1-800-676-BLUE (2583) Membership and eligibility information for your Blue Cross and Blue Shield BlueCard members Gus Manocchia, M. Version 1. 22 Status: Published . D-SNP Training | Blue Cross & Blue Shield of Rhode Island (bcbsri. You can file claims electronically or on paper for Blue Cross & Blue Shield of Rhode Island plan members and out-of-state Blue Cross & Blue Shield plan members. You also can view a quick summary of benefits below: 2025. Benefits may vary between groups/contracts. 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. May 1, 2022 · The demographics submitted in the provider portal need to match our records exactly to locate the member for any requests for authorizations. Movement of telemedicine cost sharing to match office cost sharing Dental provider portal This site is your central resource with information like patient eligibility, claims status, and payments. Dec 1, 2024 · Medicare Advantage See all your options, compare plans, and enroll. OVERVIEW . COVERAGE . 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 You can save money when you see in-network providers. Blue Cross & Blue Shield of Rhode Island is an independent licensee of the Blue Cross and Blue If the training is still outstanding after the 10-day period, the deficiency will be referred to the BCBSRI Medical Director for additional follow-up and assistance. Physician and Provider Call Center Claims and eligibility. , BCBSRI senior vice president and chief medical officer. com) b. 270/271 Health Care Eligibility Benefit Inquiry and Response Companion Guide (Real-Time and Batch) HIPAA version 5010 . com: PowerPoint Presentation (bcbsri. Services such as dental Requests for authorization of genetic testing should be submitted via the BCBSRI online prior authorization tool, which is available to BCBSRI-participating providers. for a conference call with the Provider Relations team, who will provide updates and reminders on important topics and changes for 2025. Training is available via three modes: a. Mail: Blue Cross & Blue Shield of Rhode Island. It is not a guarantee or an endorsement of a particular healthcare provider or organization. POLICY LAST REVIEWED:01 |03 2024. Navigation. com. Dental Direct Basic; Dental Direct Standard; Dental Direct Plus; Dental Direct Elite 500 exchange street, providence, ri 02903-2699 medical coverage policy | 1 (401) 274-4848 www. org In the BCBSRI MHK Provider Portal, providers will now have the ability to add a six-digit extension to their contact phone number. Please note that as a participating provider, it is your responsibility to notify members about non-covered services prior to rendering them. Services such as dental Value-based care with Prospect. POLICY LAST REVIEWED:11 |20 2024. Self-led instruction on bcbsri. The information in My Health Toolkit® can help you understand your health plan benefits. Nov 12, 2024 · for provider offices to contact BCBSRI when a provider is leaving your practice. Therefore, we would like to inform you that there is a new language resource available to you on the BCBSRI provider portal. We make reasonable effort to make sure the information displayed is accurate, but it is subject to change. Jun 1, 2022 · If you do not know who your administrator is, contact your Provider Relations representative. Medicare Advantage See all your options, compare plans, and enroll. Understanding and meeting the linguistic needs of our members is a shared concern of BCBSRI and our contracted providers. What training/education is required and/or available? MOC provider training (with attestation) is a CMS annual requirement. BCBSRI is committed to improving health equity for our members and the healthcare system. Failing to provide direct contact information may delay the provider's enrollment request. com > Providers > Forms. EFFECTIVE DATE: 03 |01 2025 . Dec 1, 2024 · Email: Medical. All Practitioner Change Forms can be faxed to Oct 1, 2024 · BCBSRI has updated our Hospital Readmission Payment policy for readmissions to an acute general short-term hospital. Blue Cross & Blue Shield of Rhode Island is an HMO and PPO plan with a Medicare contract. Relations@bcbsri. Blue Cross & Blue Shield of Rhode Island. We encourage you to submit any questions you would like addressed during the call to ProviderRelationsSeminars@bcbsri. “This is just the first step BCBSRI is taking to improve the experience for providers and their staff. 1-800-676-2583 24/7. This information is available for free in other languages. Services requiring claims submission A claim must be submitted for all services not included in a capitation compensation arrangement. org Blue Cross & Blue Shield of Rhode Island is an independent licensee of the Blue Cross and Blue Shield Association. In 2022, we launched an exciting arrangement with Prospect Health Services of Rhode Island, compensating them for taking holistic care of their nearly 10,000 BCBSRI Medicare Advantage patients, rather than for specific services provided. 500 Exchange Street. BlueLine (401) 272-1590 1-800-327-6712 24/7 How to use BlueLine. This policy documents the prior authorization request process for certain medical procedures, using the Blue Cross & Blue Shield of Rhode Island (BCBSRI) online prior authorization tool. A number of other enhancements will take place and will be communi-cated at a future date. COM EFFECTIVE DATE: 01|03|2024 POLICY LAST REVIEWED: 01|03|2024 OVERVIEW This policy documents the prior authorization request process for certain medical procedures, using the Blue Cross & Blue Shield of Rhode Island (BCBSRI) online prior authorization tool. D. Please refer to your policy for specific benefits. com Oct 1, 2024 · BCBSRI network participation. Blue Cross & Blue Shield of Rhode Island has expanded its partnership with EviCore by Evernorth to manage an additional prior authorization service for the Cardiology program for BCBSRI’s Commercial and Medicare Advance/Medicare Advantage members. BCBSRI Provider Portal: Use the Eligibility Search by Member ID in the Patient Eligibility section of the secure portal. Acupuncture benefits vary across all Medicare plans. Check claims status and patient eligibility, view remittances, and review the Provider Administrative Manual. The 2023 PQIP booklet and future updates can be found on the BCBSRI Provider Portal under Quality > PQIP. org prior to the meeting Dec 1, 2024 · PCP $0 cost sharing. Electronic inquiry : Submit a HIPAA 270 transaction (eligibility) to BCBSRI. aui yqy fgiy larfltcp aajfcrqo vqnmp zjsvbvvyx drkbk wovyzj cdk