Bcbsri provider eligibility. Provider Update, December 2019 .
- Bcbsri provider eligibility You may also use our automated referral form at Medicare Advantage See all your options, compare plans, and enroll. In the BCBSRI MHK Provider Portal, providers will now have the ability to add a six-digit extension to their contact phone number. For member eligibility, benefits & claims inquiries www. ILS Meals is one of the nation’s The following new policies were created and will be effective January 1, 2024. • 1Type the name of a doctor, medical specialty, or procedure into a network provider? Yes. But awareness of this disease – which is the third most common cancer, and third most common cause of cancer-related death in the U. Members can connect with a behavioral health provider during Claims and eligibility. Provider Directory This directory provides a list of Group BlueCHiP for Medicare’s network providers. Jan 18, 2023. 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. org Personalized Trainings: Kathleen. 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. Following the alphabetical list are listings by location and specialty, and by the type of provider. Primary care providers (PCPs) accept responsibility for arranging and coordinating the overall healthcare of BCBSRI members. 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. Outpatient providers will be routed to our new MHK tool in September, rather than the current “Clear Coverage” platform. Additional Benefits. If you have any additional questions after reviewing the information, please contact our Mental health counselors and marriage and family therapists will be allowed to render services to Medicare members. Provider Update, July/August 2022. Dec 6, 2018. Provider Update, February/October 2024 . As long as you have access to the bcbsri. 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 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) Per EOHHS, effective immediately, providers can directly bill Medicaid fee for service for SUD residential when the recipient has a Blue RI for Duals Medicare Advantage Plan. All other providers should fax the request to Utilization 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. Aug 1, 2019. These members’ FEP ID will not change. In the absence of an applicable NCD, LCD, or other CMS-published guidance, BCBSRI will apply policy determinations developed using peer-reviewed scientific evidence. com or call 1-800-639-2227 or (401) 459-5000 for a list of network providers. Printed Materials and Plan Specifics: ProviderRelations@bcbsri. ; February 15 - September 30, Effective January 1, 2024, FEP will follow CMS guidelines regarding eligibility for the FEP Medicare Prescription Drug Program (MPDP). Each year, BCBSRI is required to participate in nationally recognized quality studies, called the Healthcare Effectiveness Data and Information Set (HEDIS®). It only takes a couple of minutes and will help us improve our service. or D. This new data indicates how members of your panel of different races and ethnicities are performing relative to various HEDIS® measures. bcbsri. Provider Update, June 2020 . org Why choose BCBSRI? Network coverage; Pharmacy & prescriptions; What's included in all plans; Claims and eligibility. You will pay less if you use a provider Providers and doctors call these Blue Cross & Blue Shield Rhode Island phone numbers for eligibility and other questions. COM. A PCP is a physician (MD or DO) who is board For additional information or to find a Headway provider, please visit: Headway | Find Therapists Covered by Your Insurance or contact BCBSRI Behavioral Health Care To refer a patient to the BCBSRI BH Case Management program, please call 1-800-274-2958 or email triage_group@bcbsri. In addition, he is also In the absence of an applicable NCD, LCD, or other CMS-published guidance, BCBSRI will apply policy determinations developed using peer-reviewed scientific evidence. BCBSRI reserves the right to review and revise this policy for any reason and at any time, with We have updated the credentialing form for new providers looking to become participating BCBSRI providers. HIPAA transactions; How to file a claim; Secure portal; Provider Update; Forms; Doula application information D-SNP Training; LGBTQ+ Safe Zone Program; Contacts; FAQ; BCBSRI Provider Transparency Upload date. The training documents can be found below. ; Medicare Supplement Help cover Please note from time to time it may be necessary for our Medical Director or their designee to speak to the provider directly. Out-of-state: 1-800-676-2583. This includes services such as durable For any other provider inquiries not associated with this training, please email ClientServices@evicore. OVERVIEW . Medicare copay for telemedicine correction reminder ; New vs existing patient audit ; Last live D-SNP training dates 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. We encourage you to submit any questions you would like addressed during the call related to the topics above, or to other topics, to ProviderRelationsSeminars@bcbsri. support@evicore. S. We are currently beginning the pilot stage of our testing and are hoping to go live BCBSRI invites providers to join us on Tuesday, February 13, 2024 from 10-11 a. ” If you need guidance on verifying the information for providers in your office, please contact ProviderDirectory@bcbsri. 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 Medical Procedures are considered medically necessary when the criteria in the BCBSRI online prior authorization tool has been met. HIPAA transactions; How to file a claim; Secure portal; Provider Update; Forms; call Independent Living Systems at 833-853-8946 (toll free) and provide your BCBSRI Member ID number. Electronic attestations are now live on our secure provider portal and have replaced fax attestations. For information on member-specific BCBSRI invites providers to join us on Tuesday, March 12 from 10-11 a. You will pay less if you use a Learn more about your plan options. Back to all BCBSRI invites providers to join us on Tuesday, April 9 from 10-11 a. 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. Please ask your administrator or BCBSRI Provider Relations for Claims and eligibility. Effective January 1, 2024, FEP will follow CMS guidelines regarding eligibility for the FEP Medicare Prescription Drug Program (MPDP). Providence, Rhode Island 02903. com effective date: 02|01|2002 policy last updated: 12|17|2019 overview Durable medical equipment is considered medically necessary when the criteria in the BCBSRI online authorization tool has been met. eviCore Web Portal Assistance: Email: portal. You’ll now see a link in the sidebar called “Update Practice Info. All other providers may fax a prior authorization request to Utilization Management at (401) 272-8885. network as existing NEHP plans and BCBSRI is taking an additional step to support its members during the COVID-19 crisis. Blue Cross & Blue Shield of Rhode Island (BCBSRI) has announced it will soon be eliminating nearly 65% of prior authorization requirements for primary care providers (PCPs) Select how many miles away the provider may be from the above zip code: Within zip code 5 10 15 25 30 Languages Specialty : SEARCH TIP If you are unsure of the spelling of the For dates of service on or after October 1, 2019 providers must access EviCore by accessing the bcbsri. This Medicare Prescription Payment Plan fact sheet has helpful information about the program and will be sent to all BCBSRI Medicare Part D members. HIPAA transactions; How to file a claim; Secure portal; Provider Update; Forms; Dec 1, 2023. ) who transmits to or receives electronic data from 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 We also offer a plan, BlueCHiP Direct Advance, that includes a smaller network of providers than the BlueCHiP Direct plan. 277CA – Unsolicited claims status reports. HIPAA transactions; How to file a claim; Secure portal Our wide (and growing) network includes 12,000 providers and all Rhode Island hospitals, making it easier to get the care you need without traveling far. Any retrospective home healthcare delivered prior to On the BCBSRI MHK Provider Portal, provider correspondence is now available under the “View Authorizations” section. All other providers should fax the request to Utilization Management at (401) 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. Access provider publications including: Participating Provider Administrative network provider? Yes. FEP is transitioned in a phased rollout, so not all members’ cards will be distributed for January 1. BCBSRI will continually review NCD and LCD updates and implement appropriate policy changes. Mail: Blue Cross & Blue Shield of Rhode Island. Please review the full text of these policies in the Provider section of BCBSRI. 2022 saw a significant increase in the number of BCBSRI-certified Safe Zone providers offering safe, affirming, and inclusive care to the LGBTQ+ community. These reports are generated for all 837 transmissions and are very generic in nature. Health Trio reminder . The new plan is the HealthMate for Medicare PPO plan (HealthMate). Requests for medical procedures should be obtained via the BCBSRI online prior authorization tool, which is available only to participating providers. As a reminder, your office should log onto our secure provider portal to review members’ benefits and eligibility to verify the type of Medicare plan they chose for January 2020. This includes nurse practitioners, who can give a wide range of healthcare services and write prescriptions. com Mental health counselors and marriage and family therapists will be allowed to render services to Medicare members. Printed Materials and Plan Specifics: Your primary care provider (PCP) can coordinate your care with specialists, labs, hospitals, and any other providers you might need. BCBSRI’s PQIP booklet contains acceptable codes for each of the PQIP measures. 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 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. Effective June 1, 2024, CPT codes 81457-81459 and 81462-81464 (new codes effective January 1, 2024) will be added to this policy, will continue to require prior authorization, and will be approved when the medical criteria in this policy is met for both Medicare Advantage plans The information in My Health Toolkit® can help you understand your health plan benefits. If you are interested in BlueCHiP Direct Advance, call our sales Learn more about your plan options. Not applicable . BCBSRI has seen an increase in claims processed by out-of-network providers or laboratories which were referred by a participating BCBSRI provider. D. Medicare Advantage See all your options, compare plans, and enroll. Routine membership, eligibility, benefit information, and claims status for all BCBSRI Your primary care provider (PCP) can coordinate your care with specialists, labs, hospitals, and any other providers you might need. Brown University Health does have additional providers that are considered Tier 1 that may not be on this list. 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 In the pilot, primary care providers (PCPs) receive support from BCBSRI to identify and treat patients with depression, anxiety, and other mental health conditions. This two-step requirement includes review of course content and attestation of your review. If you have any questions regarding this new MA plan, please contact Provider Relations at. 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. com The Temporary Telemedicine Telehealth and Telephone Services During the COVID-19 Crisis policy, effective March 18, 2020, has been extended to December 31, 2020. ; Medicare Supplement Help cover costs with a Plan 65 Did you know our secured Physician and Provider Portal offers the following: • Check member benefits and eligibility • View Remittance Advices (RAs) online • View claim General Statement: Providers should verify benefits and eligibility via BCBSRI. Medicare Telemedicine Reminders; Upcoming live D-SNP training dates; Safe Zone Provider Deadline; Provider data reminders/attestation reminders Effective January 1, 2025, Pelago will be available to BCBSRI members nationally. Telemedicine ; 2024 updates; Upcoming live D-SNP training dates; Provider data reminders/attestation reminders 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. ; Medicare Supplement Help cover costs with a Plan 65 option. The requesting provider of the authorization can now Updated access to care standards for PCP’s and behavioral health providers Primary care providers (PCPs) accept responsibility for arranging and coordinating members’ CMS requires participating providers to complete an annual D-SNP, or dual special needs plan, Model of Care training. 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 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. to 6:00 p. Members can connect with a behavioral health provider during STEP 2: Choose how you want to search There are three ways you can search for providers and other healthcare services. We’re asking offices to update the link(s) if they are saved in their favorites, as the old link will no longer work. For additional information, please visit: Pelago | Virtual clinic for substance use management (pelagohealth. (PCP) groups. Here you will have the option to become a participating provider with BCBSRI. Requests for authorization of genetic testing should be submitted via the BCBSRI online prior authorization tool, which is available to BCBSRI-participating providers. See your Evidence of Coverage. Prior authorizations can be requested using the phone 1-888 BCBSRI members rated us #1 in member satisfaction among commercial health plans in the Northeast region - J. Provider Update, July 2021. Durable medical equipment is considered medically necessary when the criteria in the BCBSRI online authorization tool has been met. com provider portal to request prior authorizations beginning October 1, 2019. The Safe Zone program has BlueRI for Duals provides additional benefits and supports to both members and providers. com) or contact BCBSRI Care Management at 1-800-274-2958 or email triage_group@bcbsri. Why choose BCBSRI? Network coverage; Pharmacy & prescriptions; What's included in all plans; Your Blue Store; Claims and eligibility. Call Monday through Friday 8:00 a. This list is current as of July 1, 2024, and is subject to change. Dec 17, 2019. Check member eligibility for BCBSRI members; Confirm group benefit information for Namely, there’s a nationwide shortage of primary care providers, with more providers leaving the field than entering it. All plans offer this payment option and participation is voluntary. 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. Visit bcbsri. for a conference call with the Provider Relations team, who will provide updates and reminders 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. org; all other providers should contact Provider Relations at 1-844-707 provider call center. Here are some of the options we make available to you: • Every quarter, we directly reach out to provider Effective April 7, 2024, the Unlisted Procedures payment policy has been updated to reflect when a surgical CPT code exists for an “open” procedure only and the procedure was performed laparoscopically, the CPT code will be approved with a 20% reduction of Medicare Advantage See all your options, compare plans, and enroll. 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. the provider is what should be listed in the online directory. Please note that as a participating provider, it is your responsibility to notify members about non-covered services prior to rendering them. Simon@bcbsri. You can also use the Find a Doctor tool at bcbsri. for a conference call with the Provider Relations team, who will provide important As of January 1, 2024, home care agencies will no longer have to use the MHK provider portal to submit requests. com or call our Customer Service Department at 1-800-267-0439, October 1 - February 14, seven days a week, 8:00 a. Since the last time I wrote on this topic in January 2017’s Provider Update, BCBSRI has continued to offer providers opportunities to verify accurate practice information. 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. This policy is current at the time of publication; however, medical practices, technology, and knowledge are constantly changing. 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 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) For member eligibility, benefits & claims inquiries www. for a conference call with the Provider Relations team, who will provide important updates and reminders. PROVIDER ADMINISTRATIVE MANUAL CHAPTER 2– Key Contact List for Physicians/Providers BlueLine (401) 272-1590 or 1-800-327-6712 . com BCBSRI invites providers to join us on Tuesday, December 12, 2023 from 11-12 p. Providers may: 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. HIPAA transactions; How to file a claim; Secure portal; Provider Update; Please note this information would not be shared outside of BCBSRI. REFERENCES . Reach out to Provider. 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. Provider Update, July 2023 . Deliveries are made Monday through Friday only. This policy documents the prior authorization request Medicare Advantage See all your options, compare plans, and enroll. Use the Find a Doctor tool if your vision exam is covered under your medical plan. HIPAA transactions; How to file a claim; Secure portal; BCBSRI’s PQIP program currently includes three diabetes-specific HEDIS measures that encompass important aspects of monitoring in patients with diabetes: It may also ease the mental load providers often face when addressing diabetic care during an already Primary care providers (PCPs) accept responsibility for arranging and coordinating the overall healthcare of members. Check patient eligibility to verify effective dates of coverage, copays, deductibles, and other information. com or by calling the Provider Service Center at 401-274-4848 or 1-800-230-9050 prior to requesting any BCBSRI invites our participating providers to join us on Tuesday, November 12 from 10-11 am. To individually credential your LCDP’s today, you can do so by clicking here. Healthy choices earn rewards You and your employees can earn with Wellness Premium Reward. The full texts of these policies are available in the Provider section of bcbsri. See your Evidence of Providers are tiered and can find their tier status by using the BCBSRI Provider Finder. com Dental Provider Call Center: (401) 453-4700; or 1-800-831-2400 wish to participate in the BCBSRI provider network have appropriate qualifications and meet credentialing requirements as set As the updated policies are effective for dates of service January 1, 2021 and after, providers will no longer need to append the CR modifier to ANY of their telemedicine claims. See full details of the policies here, and if you have any questions, please contact your Provider Relations Representative or ProviderRelations@bcbsri. The information in My Health Toolkit® can help you understand your health plan benefits. Box 69427 Harrisburg, PA 17106 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 Medical Procedures are considered medically necessary when the criteria in the BCBSRI online prior authorization tool has been met. for a conference call with the Provider Relations team, who will provide updates and reminders on important topics and changes for 2025. Care Team and Medicaid Benefit Coordination. , CPE is BCBSRIs senior medical director for clinical transformation. BCBSRI will require that all LCDP’s are individually credentialing by February 1, 2025. 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. The four fields in the member search are set to be exact match Provider Update, February/October 2024 . to 8:00 p. unitedconcordia. A PCP is a physician (M. It does not describe all the parts of the plan or guarantee payment, reimbursement or eligibility of coverage. It offers the next step in the evolution of BCBSRI’s PCP- and referral-required New England Health Plan product line, with the first tiered regional product offered by a Rhode Island-based health plan. Please refer to your policy for specific benefits. 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. If you provider is listed on BCBSRI but not appearing in your BCBSRI invites providers to join us on Tuesday, December 10, 2024 from 10-11 a. • Use the ‘Common Search’ feature to select from one of six options: Radiology & Imaging Centers, Labs & Tests, DME & Medical Supplies, Physical BCBSRI is taking an additional step to support its members during the COVID-19 crisis. For providers who require Sign in to your Blue Cross Blue Shield of Rhode Island account. ) who transmits to or receives electronic data from BCBSRI. – 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 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. specific For information on member As of January 1, 2024, home care agencies will no longer have to use the MHK provider portal to submit requests. 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. Routine membership, eligibility, benefit information, and claims status for all BCBSRI Effective January 1, 2025, BCBSRI will be moving from facility contracting and billing and will start credentialing LCDP’s individually. If you have Blue Cross Vision, use this option for routine eye exams, glasses, and contacts. Email: Medical. Dr. If all of your required credentialing documents are current, we will access the information and process the application. Requests for DME should be obtained via the BCBSRI Find an eye doctor. effective date: 11 |01 2024 policy last reviewed: 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. BCBSRI reserves the right to review and revise this policy for any reason and at any time, with 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. Medicaid Enrollment / Please note that only your office administrator can add providers to your BCBSRI. May 16, 2024. 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; 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. You will be notified by BCBSRI if you have missing or outdated documents. Navigation. 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 Colorectal Cancer Awareness Month is observed every March. You can verify BlueCHiP Direct Advance members by validating the prefix code ZBE on the member identification card. The four fields in the member search are set to be exact BCBSRI has seen an increase in claims processed by out-of-network providers or laboratories which were referred by a participating BCBSRI provider. Claims and eligibility. Additional features include the ability to access clinical criteria, check member eligibility, upload additional clinical information, and schedule clinical consultations. Provider Inquiry is for registered, nonregistered and out-of-state providers. Telemedicine ; 2024 Updates; Upcoming live D-SNP training dates; Provider data; We encourage you to submit any questions you would like addressed 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. This medical policy is made available to you for informational purposes only. BCBSRI invites providers to join us on Tuesday, February 13, 2024 from 10-11 a. support@bcbsri. Attention: Medical Policy, CPT Review. com. com under the Medical Policy heading. Provider Update, December 2019 . Electronic inquiry: Submit a HIPAA 270 transaction (eligibility) to BCBSRI. If (401) 274-4848 WWW. See www. 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 Please note that only your office administrator can add providers to your BCBSRI. POLICY LAST REVIEWED:01 |03 2024. Requests for DME should be obtained via the BCBSRI online prior authorization tool, which is available only to participating providers. . Secure messaging is located on the left Here you will have the option to become a participating provider with BCBSRI. This includes services such as durable 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. com account. Jul 8, 2022. Manage Your Plan; Prescription Drugs; Find Care; See Plan Perks; Live Healthy Effective January 1, 2024, FEP will follow CMS guidelines regarding eligibility for the FEP Medicare Prescription Drug Program (MPDP). com: Ambulatory Blood Pressure Monitoring; Modifier 59 XE XP XS XU; Surgical Left Atrial Appendage Occlusion Devices for Stroke Prevention in Atrial Fibrillation; Synthetic Cartilage Implants for Medicare Advantage See all your options, compare plans, and enroll. BlueLine (401) 272-1590 1-800 The information in My Health Toolkit® can help you understand your health plan benefits. org for assistance. org prior Gonzalo Paz-Sold á n, M. Claims filing Electronic claims. provider call center. Genomic Sequence Analysis Panels in the Treatment of Solid Organ Neoplasms . Their FEP ID will not change. 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 As a reminder, there is a functionality on the BCBSRI Provider Portal that allows providers to send inquiries via secure messaging. After successful login to bcbsri. • Use the ‘Common Search’ feature to select from one of six options: Radiology & Imaging Centers, Labs & Tests, DME & Medical Supplies, Physical The Temporary Telemedicine Telehealth and Telephone Services During the COVID-19 Crisis policy, effective March 18, 2020, has been extended to December 31, 2020. 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 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). m. Medicare Advantage See all your options, compare plans, and enroll. The 2023 PQIP booklet and future updates can be found on the BCBSRI Provider Portal under Quality > 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. com click on the Preauthorization hyperlink on the left-hand side Note: Please remember to always verify a member’s eligibility on BCBSRI. A PCP is a physician (MD or DO) who is board-certified or trained in internal medicine, pediatrics, or family medicine. com prior to requesting authorization. Send paper claims to: Dental Claims Administrator P. Wide network with more than 12,000 providers; $0 copays for primary care provider (PCP) visits; $0 preventive services like well visits, screenings, and vaccinations; Point of service (POS) benefit for out-of-state flexibility; Some services require referrals. com click on the Preauthorization hyperlink on the left-hand Note: Please remember to always verify a member’s eligibility on BCBSRI. Paz-Sold á n joined us in June 2022 and is helping to lead our clinical efforts to enhance our members’ experience and advance the quality of care they receive through the growth and expansion of our value-based programs and initiatives. Effective January 1, 2020, BCBSRI will become the insurer for all Lifespan employees. If you have any questions about this change, please contact ProviderRelations Medicare Advantage See all your options, compare plans, and enroll. This includes services such as durable We offer two ways to find patient eligibility information — by logging into our secured provider portal or by calling Provider Inquiry, an automated response system. org. Please continue to use your BCBSRI payer ID when submitting electronic claims. 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 under our medical benefit. These providers have dedicated time slots available exclusively for BCBSRI members. The codes included in this booklet are the most commonly used, but are not exhaustive. O. HIPAA transactions; How to file a claim; Secure portal; Provider Update; Forms; Provider Credentialing and Recredentialing Process Upload date. CMS requires participating providers to complete an annual D-SNP, or dual special needs plan, Model of Care training. In order to register as a BCBSRI Trading Partner and begin testing, it is necessary to complete the Trading Partner Registration (TPR) form. 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. FEP is transitioned in a phased rollout, so not all members card will be distributed for 1/1/24. The NPI and Tax ID you enter must match what’s in BCBSRI’s system. As a BCBSRI-contracted Self-guided Study: Complete the 2025 Provider Attestation form CMS Annual Requirement for ALL providers, cannot be delegated. 500 Exchange Street. Manage Your Plan; Prescription Drugs; Find Care; See Plan Perks; Live Healthy Become a participating provider Use this form to add a new practice or a new provider within a Claims and eligibility. 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. ; Extra Help Plans Medicare + Medicaid and the new Access plans. • 1Type the name of a doctor, medical specialty, or procedure into the search bar. Accordingly, the Rhode Island Department of Human Services (DHS) will be resuming eligibility redeterminations for Medicaid members on April 1, 2023. In the pilot, primary care providers (PCPs) receive support from BCBSRI to identify and treat patients with depression, anxiety, and other mental health conditions. network as existing NEHP plans and We have updated the credentialing form for new providers looking to become participating BCBSRI providers. When you are due for recredentialing, BCBSRI will verify with CAQH that you have a current application on file. As always, we ask that you verify BCBSRI member benefits and eligibility by logging on to the secure provider portal of bcbsri. PCPs who have any questions regarding this product can contact pcprequests@bcbsri. As part of our overall efforts to support primary care in Rhode Island, BCBSRI realized we needed to do something to address this situation. If you have any additional questions after reviewing the information, please contact our Provider & Physician Call Center at (401) 274-4848. Members can opt in to this program if they are actively enrolled in a Medicare Part D plan. 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 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. BCBSRI. A BCBSRI EDI trading partner is any business partner (provider, billing service, software vendor, employer group, financial institution, etc. Let us know what you think. Failing to provide direct contact information may delay the provider's Blue Cross & Blue Shield of Rhode Island (BCBSRI) providers, who are also participating providers with the member’s vision benefit plan, should follow the contractual and claims filing guidelines of the vision benefit plan. This plan offers the freedom to choose the providers and pharmacists the patient wants to see. These members’ FEP ID cards will not change. Self-guided Study: Complete the 2025 Provider Attestation form CMS Annual Requirement for ALL providers, cannot be delegated. If you have any additional questions about these changes or Primary care providers (PCPs) accept responsibility for arranging and coordinating the overall healthcare of BCBSRI members. All other providers should fax the request to Utilization Let us know what you think. Please ask your administrator or BCBSRI Provider Relations for assistance adding your provider to BCSRI. Feb 14, 2019. This two-step requirement includes review of course BCBSRI has seen an increase in claims processed by out-of-network providers or laboratories which were referred by a participating BCBSRI provider. com Dental Provider Call Center: (401) 453-4700; or 1-800-831-2400 wish to participate in the BCBSRI provider network have appropriate qualifications and meet credentialing requirements as set Requests for authorization of genetic testing should be submitted via the BCBSRI online prior authorization tool, which is available to BCBSRI-participating providers. EFFECTIVE DATE: 01 |01 2025 . For any other provider inquiries not associated with this training, please email ClientServices@evicore. 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 While many PCPs are doctors, other providers can also be PCPs. com, in addition to the languages spoken, which are displayed today. Power. All other providers should fax the request to Utilization Management at (401). This type of coordinated care makes it easier for you to 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 Coming soon BCBSRI will be introducing online web claim submission through bcbsri. If you have any questions regarding this change, please contact ProviderRelations@bcbsri. Some services require referrals. BCBSRI offers multiple training modalities and sessions for providers to meet these requirements. ) who is board-certified or trained in internal medicine, pediatrics, or family medicine. NEHP tiered network . This plan uses a provider network. Please note this information would not be shared outside of Durable medical equipment is considered medically necessary when the criteria in the BCBSRI online authorization tool has been met. i. Physicians and professionals: 1-800-344-8525; Hospitals or facilities: 1-800-249-5103 Become a participating provider Use this form to add a new practice or a new provider within a Claims and eligibility. com 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 Soon we will begin publishing that provider data in our Find a Doctor provider directory on bcbsri. Our goal is to make sure that our members continue to have access to effective medications at the lowest possible cost. Below is a quick overview about how this plan effects providers: All providers participating in the Blue network are included in Lifespan’s coverage. Policy@bcbsri. STEP 2: Choose how you want to search There are three ways you can search for providers and other healthcare services. Biomarker Testing Mandate; Blood Product Molecular Antigen Typing The following policies were recently reviewed for annual update. edi. 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. If you have any additional questions about these changes or webinar registration, please contact Provider Relations at 1-844-707-5627 or ProviderRelations@bcbsri. P B F. Paper claims. After completing the training, you are to complete the D-SNP Provider Attestation Form below. HIPAA transactions; How to file a claim BCBSRI Update. How can providers help? BCBSRI has updated our Hospital Readmission Payment policy for readmissions to an acute general short-term hospital. com to confirm member coverage prior to rendering services. As a result of these reviews, providers may be asked for medical records and billing documents that support the charges billed. for a conference call with the Provider Relations team, who will provide updates and reminders on the following topics:. Our EDI team can be reached via email at hipaa. If your doctor is not yet in the BCBSRI network, they can use this form to request participation: Become a participating provider 500 exchange street, providence, ri 02903-2699 medical coverage policy | 1 (401) 274-4848 www. org for any additional issues 1. ProviderRelations@bcbsri. If you have any questions about this change, please contact ProviderRelations Claims and eligibility. An important component of our commitment is our continued efforts to reward primary care providers (PCPs) for improving quality and closing Dental provider portal This site is your central resource with information like patient eligibility, claims status, and payments. Click the below link to explore our formularies and UM criteria: BCBSRI invites providers to join us on Tuesday, November 14, 2023 from 10-11 a. Phone: 1-800-646-0418 (option 2) BCBSRI has updated our Hospital Readmission Payment policy for readmissions to an acute general short-term hospital. It does not describe all the parts of the plan or guarantee payment, reimbursement or eligibility of BCBSRI Provider Portal: Use the Eligibility Search by Member ID in the Patient Eligibility section of the secure portal. A denial from the Medicare Advantage Plan is no longer required by Medicaid for the following codes: H0001 UD – Alcohol and /or drug assessment 60-90 minutes 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. This includes, but is not limited to, filing claims for routine eye care services to the member’s vision benefit plan. If you do have any questions regarding your physician’s tiering, please reach out to the CARE Team. FEP members will begin to receive new cards. This policy is applicable to facilities reimbursed based on a contracted diagnosis-related group (DRG) or case rate methodology. Providers are tiered and can find their tier status by using the BCBSRI Provider Finder. Any errors on these reports are either Provider or member related. Failing to provide direct contact information may delay the provider's 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. the addition of Network Blue New England Options. The updated form can be found here. View PDF. Relations@bcbsri. This application is for adding new providers within a practice who are not already participating with BCBSRI, and 2022 saw a significant increase in the number of BCBSRI-certified Safe Zone providers offering safe, affirming, and inclusive care to the LGBTQ+ community. 500 exchange street, providence, ri 02903-2699 medical coverage policy | 1 (401) 274-4848 www. 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. BCBSRI. gumc dczqbda ukwasm yyywmq kgogniou avji ndgypm tfyui kkkwma umqext
