Bcbsri provider benefits. POLICY LAST REVIEWED:11 |20 2024.
- Bcbsri provider benefits Click on this link to learn more and help members stretch their budgets by maximizing their benefits at pharmacy and provider office visits. Fill out the required information & click “Go. Effective January 1, 2014, Pediatric Services including oral care has been defined as an Essential Health Benefit. If you are having trouble receiving your PIN, please contact Provider Relations at ProviderRelations@bcbsri. This feature will show any open authorizations and up to six months of approved authorizations. If you provide The purpose of this Blue Cross & Blue Shield of Rhode (BCBSRI) Provider Credentialing and Recredentialing Policy, herein referred to as “Policy,” is to ensure the systematic review of health care benefits, call the provider call center. Medicare Advantage plans; Extra Help plans; Medicare Supplement; FAQ; Search for providers. The updated form can be found here. Training Objectives. EFFECTIVE DATE: 03 |01 2025 . BCBSRI Update PBF PBF Important: verify your practice information! BCBSRI Learn more about your plan options. You must receive all routine care from plan providers unless you select the BlueCHiP for Medicare Value (HMO-POS), BlueCHiP for Medicare Enhanced (HMO-POS), BlueCHiP for Medicare Extra (HMO-POS), If administered at a physician’s office or by a home infusion provider outside the BCBSRI network: To get the maximum benefit when specialty drugs are administered by nonparticipating providers (including providers who participate with another Blue Cross and Blue Shield plan through the BlueCard Network), members must ensure that: All codes and services will apply the appropriate member cost share under their benefit plan. WINFertility update. If you The dental benefits included in our Medicare Advantage plans are considered supplemental benefits and are not covered by traditional Medicare. Acupuncture benefits vary across all Medicare plans. Dental coverage: $3,000 annual benefit max + dentures, implants, crowns and so much more! • Up to 2 hearing aids for $0 + batteries • $1,500 / yr. ” Upon completion of the form, your PIN will be emailed to you. Following the call, we will post a summary of topics covered to our Provider Conference Info page on our secure provider portal. Prices, brands, and items vary from store to store. This is the most a member would pay for these services during a calendar year. Check claims status and patient eligibility, view remittances, and review the Provider Administrative Manual. Flexible Benefit Card, gym membership, and other (UM) criteria are available online? The formulary is a great tool to help members and providers understand what drugs 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 and Full Benefit Dual Eligible (FBDE). Please note that as a participating provider, it is your responsibility to notify members about non-covered services prior to rendering them. $4,800 annually for services you receive from in-network providers. Routine membership, eligibility, benefit information, and claims status for all BCBSRI Flexible Benefit Card, gym membership, and other benefits The $0 BlueCHiP for Medicare Access (HMO-POS) plan offers affordable benefits. $10,000 annually for services you receive from out-of-network providers. Medicare Advantage plans; Extra Help plans; Medicare Supplement; FAQ; Special enrollment period; Physician and Provider Service Center (401) Sign in to your Blue Cross Blue Shield of Rhode Island account. Simply click the hyperlink of the correspondence you wish to view and the correspondence will appear in a new window. Provider Update, May 2022 . ) who transmits to or receives electronic data from BCBSRI. Click on Forms. history, including the date, the provider, and the amount paid. A PCP is a physician (MD or DO) who is board-certified or trained in internal medicine, pediatrics, or family medicine. your office should log onto our secured provider portal to review members’ benefits and eligibility to We encourage you to submit any questions you would like addressed during the call to ProviderRelationsSeminars@bcbsri. participating BCBSRI provider to admit on my behalf. P B F. This means that BCBSRI providers will not be able to refer BCBSRI or members of other Blue Plans who are receiving services Coming soon BCBSRI will be introducing online web claim submission through bcbsri. BCBSRI encourages healthcare providers in our participating network to collaborate with us in support of the LGBTQ (lesbian, gay, bisexual, transgender, queer) community. The NPI and Tax ID you enter must match what’s in BCBSRI’s system. You may also use our automated referral form at BCBSRI. 4. View PDF. May 1, 2024. Medicaid Enrollment / Eligibility Support. If you use providers that are not in our network, the plan may not pay for these services. All other providers may fax a prior authorization request to Utilization Management at (401) 272-8885. schedules will be available on bcbsri. • Select your primary care provider • Manage your HSA or HRA • Make a monthly premium payment 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. benefits and to outline the payment policies of Blue Cross & Blue Shield of Rhode Island (BCBSRI) when coordinating benefits due to the presence of other coverage. Dec 1, 2024. Log in to bcbsri. This program lets Medicare try new ways to improve Medicare Advantage plans. You must generally use network pharmacies to fill your prescriptions. Out-of-state: 1-800-676-2583 Flexible Benefit Card, gym membership, and other benefits Start here. Please refer Access provider publications including: Participating Provider Administrative Manual; BCBSRI Practice Guidelines; Orientation visits. 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). Medicare’s Annual Enrollment Period is now in effect and runs until December 7, for coverage effective January 1, 2023. Covered Acupuncture . Click on Tools and Resources. This list is current as of July 1, 2024, and is subject to change. Covered acupuncture . POLICY LAST REVIEWED: 08|21|2024 . You may also call the BCBSRI Physician & Provider Service Center at (401) 274-4848 or 1-800-230-9050. This includes services such as durable Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 07/01/2023 - 06/30/2024 a network provider? Yes. Please refer to the appropriate Benefit Booklet, Evidence of Coverage, or Subscriber Agreement for applicable coverage for benefits/coverage. Overview; Shop; We have updated the credentialing form for new providers looking to become participating BCBSRI providers. All BCBSRI Medicare Advantage members will receive a debit card loaded with $25-$200/quarter (depending on the plan – see the chart below) to purchase a wide range of health-related Our BlueCHiP for Medicare (HMO-POS) plans, the most popular Medicare Advantage plans in Rhode Island, all include $0 primary care provider visits, $0 dental, vision, and hearing, a $0 pharmacy deductible, $0 generic drugs, a Flexible Benefit Card, and a large network with a point of service (POS) option. The new plan is the HealthMate for Medicare PPO plan (HealthMate). And remember, the best time to register with Doctors Online is before you need care. Provider Update, April 2021 . Small offices will be able to submit claims directly through bcbsri. So call your primary care provider (PCP) today! 2. The Web Administrator for your Provider Claims Pre-Treatment Estimates . for a Flexible Benefit Card, gym membership, and other benefits Start here. We comply with applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, disability, or sex. Overview; Shop; Primary care providers (PCPs) accept responsibility for arranging and coordinating the overall healthcare of BCBSRI members. COM. Providers may also collaborate with BCBSRI on medical records requests. Providers can perform various actions TMS Benefit is now considered a BH outpatient benefit Effective July 3, 2023, the all TMS services are now processing as an outpatient Behavioral Health benefit. We’ll explain everything you need to know about the $0 benefits that come with our BlueCHiP for Medicare (HMO-POS) plans and the extra benefits you could get if you qualify for Extra Help or Medicare + Medicaid. On January 1, BlueCare Connect will replace myBCBSRI. Benefits Booklet – Find information about covered healthcare services, benefit limits (e. Services are covered under the member durable medical equipment benefit and the services do not require prior If you would like to become a BCBSRI LGBTQ Safe Zone certified practice, please contact Susan Walker, provider relations manager, at (401) 459-5381 or susan. 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. Monthly Plan Premium $38 per month Value (HMO - POS) BlueCHiP for Medicare Copays for hospital benefits (In 2025 that drops to $2,000. Future Plans for D-SNP. This includes services such as durable diagnostic test of the individual’s germline will benefit the individual and one of the following criteria is met: tool, which is available to BCBSRI-participating providers. Headway matches providers with members based on the geographic location In previous Provider Update issues, we’ve consistently reached out to our provider community to remind you of your obligation, as a Blue Cross & Blue Shield of Rhode Island (BCBSRI)-contracted provider, to coordinate members’ care with contracted, in-network providers and facilities. (Apria) a DME provider with locations in East Providence, RI; Norwood, MA; and Worcester, MA, will be an out-of-network provider effective January 1, 2015. This includes, but is not limited to, filing claims for routine eye care services to the member’s vision benefit plan. Credentialing. com on October 1, 2024. All Medicare and Medicaid benefits . pdf Submit D-SNP member claims to BCBSRI for benefit review and disbarment. Dental Providers: The filing limit for claim submission for services to Blue Cross Blue Shield of Rhode Island (BCBSRI) for Dental services is 365 days from the date of service. This means we require BCBSRI-contracted providers to Email: Medical. Effective January 1, 2025, BCBSRI will remove the non-skilled benefit for all Medicare Advantage plans except BlueRI for Duals (D-SNP). g. The purpose of this Blue Cross & Blue Shield of Rhode (BCBSRI) Provider Credentialing and Recredentialing Policy, herein referred to as “Policy,” is to ensure the systematic review of health care benefits, call the provider call center. BCBSRI. Starting January 1, 2021, all BlueCHiP for Medicare plans include an over-the-counter (OTC) benefit program enhancement. Fill out the required information & select “Go. You can view our plan’s from in-network providers. Purchases made online or by phone using the catalog may also be different than what you find in stores. To attend the session online, please join using Microsoft Teams. When entering a Servicing or Facility Provider, you may be presented with a choice to select either Par or Contracted status in the Servicing Provider field - Par should always be selected. Find out which doctors and hospitals are part of the extensive Blue Cross network. PROVIDER ADMINISTRATIVE MANUAL CHAPTER 2– Key Contact List for Physicians/Providers BlueLine (401) 272-1590 or 1-800-327-6712 . Transcript. In order to register as a BCBSRI Trading Partner and begin testing, it is necessary to complete the Trading Partner Registration (TPR) form. BCBSRI forms. If you provider is listed on BCBSRI but not appearing in your authorization request screen, please ensure this information is correct and updated with BCBSRI. Pulse oximeters are included as part of this OTC benefit. Previous versions. As a participating dentist with BCBSRI, you are part of the BCBSMA network, and agree . copayments, deductibles, coinsurance), New: The benefit limit is $1,500 per hearing aid per occurrence. ” 3. ; Medicare Supplement Help cover costs with a Plan 65 option. Credentialing@bcbsri Unused benefits do not roll over to the next benefit period. Policy@bcbsri. Provider Update, January 2020 . You cannot exceed your quarterly benefit amount. Since BCBSRI negotiates discounted rates from providers in our network, you pay less for your services. In some instances, benefits for Medicare Advantage Plans may be greater than what is BCBSRI has seen an increase in claims processed by out-of-network providers or laboratories which were referred by a participating BCBSRI provider. Failing to provide direct contact information may delay the provider's Copays for hospital benefits are based on per admission/per stay. Please note this information would not be shared outside of BCBSRI. BCBSRI Cost Share Waiver for Primary Care Physicians and Midlevel Primary Care Providers BCBSRI will waive all member cost share for BCBSRI subscribers (waiver of the cost share does not For any other provider inquiries not associated with this training, please email ClientServices@evicore. Our plan covers up to 100 days in a Copays for SNF benefits are based on benefit periods. for a conference call with the Provider Relations team, who will provide updates and reminders on the following topics:. To refer a patient to the BCBSRI BH Case Management program, please call 1-800-274-2958 or email triage_group@bcbsri. com or call 1-800-639-2227 or (401) 459-5000 for a list of network providers. Other updates BCBSRI has also made other rate adjustments in its fee schedule, both upward and downward, generally following Medicare changes and continuing Flexible Benefit Card, gym membership, and other benefits Start here. P. for a co P B F . This update will change the Methadone Maintenance benefit to the following: Starting January 1, 2023, upon a plan’s renewal, BCBSRI will adjust existing methadone maintenance benefit to $0 copay or 0% post deductible both in-network and out-of-network ^Additional Benefits are available to members who have selected a High-Value Provider as their Primary Care Provider. 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. To access your fee schedule, you can log on to our We will soon begin publishing provider race and ethnicity in our Find a Doctor provider directory on bcbsri. You must receive all routine care from plan providers unless you select the BlueCHiP for Medicare Value (HMO-POS), BlueCHiP for Medicare Extra (HMO-POS), BlueCHiP for Medicare Preferred (HMO-POS), or the HealthMate for Medicare (PPO) plan. Reimbursing members. Flexible Benefit Card, gym membership, and other benefits Start here. You can view our plan’s Medicare Advantage See all your options, compare plans, and enroll. For plans with tiered networks where the Subscriber Agreement includes a process for requesting coverage of higher-tier provider services at the lower-tier benefit level, covered healthcare services from the higher-tier provider are Medicare Advantage See all your options, compare plans, and enroll. Some of these drugs will continue to require prior authorization (PA) under the BCBSRI Medical Drug Review (MDR) program administered by Prime Therapeutics, LLC, our pharmacy benefits manager. If you have questions about the member’s vision hardware benefit, please call our Provider Service Center at (401) 274-4848, or 1-800-230-9050. ProviderRelations@BCBSRI. Vendors current as of October 1 Effective January 1, 2025, BCBSRI will remove the non-skilled benefit for all Medicare Advantage pla P F . Services are covered under the member durable medical equipment benefit and the services do not require prior Please refer to the appropriate Benefit Booklet, Evidence of Coverage, or Subscriber Agreement for applicable telemedicine services benefits/coverage. Improving member outcomes through world-class financial technology, supplemental benefits management, advanced analytics, and custom outcomes programs. BCBSRI’s PQIP booklet contains acceptable codes for each of the PQIP measures. 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. com to get started. You will pay less if you use a provider in the plan’s Our members with behavioral health needs can benefit from a pilot program we launched with the Women’s Medicine Collaborative at Lifespan. For example- $3000 a year in dental coverage, $275 per quarter OTC card, $300 vision hardware, 50 one way rides to medical For information call the BCBSRI Provider Call Center, at (401) 274-4848. Call us if you’d like an orientation at your office about provider publications or: Online preauthorization requests – This is a convenient way to submit preservice or aftercare authorization requests. This update will change the methadone maintenance benefit to the following: Starting January 1, 2023, upon a plan’s renewal, BCBSRI will adjust the existing methadone maintenance benefit to a $0 copay or 0% post-deductible, both in-network and out-of-network. Effective January 1, 2025, BCBSRI will be removing the non-skilled benefit for all Medicare Advantage plans except BlueRI for Duals (D-SNP). You cannot exceed your benefit amount. This will be considered a non-covered benefit. com provider porta P B F . The codes included in this booklet are the most commonly used, but are not exhaustive. However, I would like to be given the opportunity to Effective January 1, 2020, BCBSRI will become the insurer for all Lifespan employees. This update will change the methadone maintenance benefit to the following: Effective January 1, 2023, upon a plan’s renewal, BCBSRI will adjust the existing methadone maintenance benefit to a $0 copay or 0% post-deductible, both in-network and out-of-network. To ensure providers wishing to participate in the BCBSRI provider network have appropriate qualifications and meet credentialing requirements as set forth in the BCBSRI Medicare Advantage See all your options, compare plans, and enroll. However, there are new enhanced no cost share benefits for primary care and behavioral health Any BCBSRI provider in-network with the D-SNP network, will be required to take an initial training that is due by March Additional benefits include networking opportunities, a different perspective on the healthcare system, and developing skills for future leadership opportunities. walker@bcbsri. m. 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. No special request or patient authorization is needed. As a reminder, you should always review member benefits and eligibility on bcbsri. Please note that some systems of care (SOCs) have developed an alternative process to submit an online referral to BCBSRI’s Medicare Advantage plans are the highest rated in Rhode Island– we recently received the Centers for Medicare & Medicaid Services’ (CMS’) highest Star rating possible – 5 out of 5 Stars – for our 2023 Medicare Advantage HMO and PPO plans. Your guide to better health at Blue Cross Blue Shield of Rhode Island. you may need a referral from your primary care provider Record the member’s BlueRI for Duals and Anchor cards in your EMR to ensure the member is accessing their fullest coverage for both of their plans. Please note from time to time it may be necessary for our Medical Director or their designee to speak to the provider directly. As a BCBSRI-contracted provider, it is your obligation to coordinate member care with contracted, in-network providers, for all BCBSRI plans and products. You pay these amounts each benefit period until you reach the in-network or out-of-network out-of-pocket maximum. 500 Exchange Street. OVERVIEW . Box 986005 . The requesting provider of the authorization can now view correspondence which have been sent via fax or mail. Blue365 – Gain access to health- and wellness- related deals on fitness products, gym memberships, healthy eating, and more. For any other provider inquiries not associated with this training, please email ClientServices@evicore. We’re asking offices to update the link(s) if they are saved in their favorites, as the old link will no longer 500 EXCHANGE STREET, PROVIDENCE, RI 02903-2699 MEDICAL COVERAGE POLICY | 2 (401) 274-4848 WWW. Benefits of the meal delivery program are: ILS Meals is one of the nation’s largest nutritional providers, delivering high-quality, medically tailored Flexible Benefit Card, gym membership, and other benefits Start here. COM Provider Update, March 2018 Provider Update, June 2017 Provider Update, March 2012 Effective January 1, 2025, BCBSRI will remove the non-skilled benefit for all Medicare Advantage pla P F . This is often a significant savings. Secure messaging is located on the left-hand tool bar once you log in to bcbsri. If something is not covered by the plan, you as a provider cannot bill the member for this type of plan but can bill to other providers. BlueRI for Duals (HMO D-SNP) has a network of doctors, hospitals, pharmacies and other providers. Understanding and meeting the linguistic needs of our members is a shared concern of BCBSRI and our contracted providers. COM EFFECTIVE DATE: 01|03|2024 POLICY LAST REVIEWED: 01|03|2024 Benefits may vary between groups/contracts. plus: • Ancillary Benefits: Dental services up to $3,000 $300 for glasses Hearing aids and batteries Comprised of the member and/or caregiver, providers, and BCBSRI care team. 1. BCBSRI invites providers to join us on Tuesday, December 10, 2024 from 10-11 a. • When coordinating benefits with Medicare Advantage See all your options, compare plans, and enroll. to 4:30 p. org if you have any questions about this process Apria Healthcare, Inc. MEDICAL CRITERIA Not applicable PRIOR AUTHORIZATION (401) 274-4848 WWW. Provider Update, February 2023 . Provider Update, April 2024 . physicians and Durable Medical Equipment providers when medically necessary and ordered by a physician/provider. If the member has a PPGRI PCP, you will be transferred to BCBSRI provider agreement. Claims filing Electronic claims. 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 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). Benefits of the meal delivery program are: ILS Meals is one of the nation’s largest nutritional providers, delivering high-quality, medically tailored If you would like to become a BCBSRI LGBTQ Safe Zone certified practice, please contact Susan Walker, provider relations manager, at (401) 459-5381 or susan. Radiation Therapy benefit change. POLICY LAST REVIEWED:11 |20 2024. Refer to BCBSRI’s COT Category II Code guide, or see the PCP Quality Incentive Program booklet. Boston, MA 02298 Boston, MA 02298 . Click here to request a Request a Provider Identification Number (PIN). org . If you provide services to a member which are determined to not be medically necessary (or in some Please ask your administrator or BCBSRI Provider Relations for assistance adding your provider to BCSRI. benefits, call the provider call center. Please continue to use your BCBSRI payer ID when submitting electronic claims. , On the BCBSRI MHK Provider Portal, provider correspondence is now available under the “View Authorizations” section. Have $0 preventive cancer screenings. EFFECTIVE DATE: 02|05|2024. The 2023 PQIP booklet and future updates can be found on the BCBSRI Provider Portal under Quality > benefits tailored to the dual eligible population. BCBSRI members rated us #1 in member satisfaction among commercial health plans in the Providers and doctors call these Blue Cross & Blue Shield Rhode Island phone numbers for eligibility and other questions. Radiation Therapy benefit is moving to a 20% coinsurance. Comprised of the member and/or caregiver, providers, and BCBSRI care team. $7,500 annually for services you receive from out-of-network providers. These are Blue Cross Dental products that are embedded in the Medicare Please contact the BCBSRI Provider Relations team at . Provider Update, March 2018 We have updated our IVR and provider portal to reflect the August 1, 2020 changes, and we encourage providers to use these tools to verify benefits. BCBSRI strives to minimize provider disruption, by coordi-nating HEDIS and risk adjustment medical record requests. High-Value Provider network consists of Care New England, Oak Street Health, and Prospect CharterCARE primary care provider (PCP) groups. _____I wish to participate/continue my participation with BCBSRI. Medicare copay for telemedicine correction reminder ; New vs existing patient audit ; Last live D-SNP training dates Flexible Benefit Card, gym membership, and other benefits Start here. (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 Flexible Benefit Card, gym membership, and other benefits Start here 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. Therefore, we would like to inform you that there is a new language resource available to you on the BCBSRI provider portal. 2. Overview; Shop; BCBSRI Update. COM Commercial products. Medicare Advantage See all your options, compare plans, and enroll. Send paper New: The benefit limit is $1,500 per hearing aid per occurrence. . Provider Update, March 2018 Flexible Benefit Card, gym membership, and BCBSRI providers can view authorizations in the MHK provider portal by expanding the drop-down and selecting “View Authorizations” on the left side of the page. Overview; Shop; Provider Appeal Request Form. com account or need to make changes to a provider’s demographic information, please contact Provider Relations. Click on Case Management BCBSRI invites providers to join us on Tuesday, February 13, 2024 from 10-11 a. 3 You must use network pharmacies to access your prescription drug benefit, except under non-routine BCBSRI has seen an increase in claims processed by out-of-network providers or laboratories which were referred by a participating BCBSRI provider. BCBSRI Medicare Advantage Non-Skilled Home Health Care Benefit – FAQ. Check out BlueCHiP for Medicare Access BCBSRI always goes above and beyond to make sure I'm receiving the best Medicare Advantage See all your options, compare plans, and enroll. Benefits tab and select the applicable Service Category and Service Type to see if a referral is required. org. The radiation therapy benefit is moving to a 20% coinsurance. Box 986005 P. myBCBSRI gives you quick, easy access to your digital ID cards, claims, and benefits. Log on to the provider portal of BCBSRI. Here you can see how much you saved on services listed on the HSS. 2 Doctors Online is a telemedicine service provided by American Well®, an independent company that administers Doctors Online on behalf of BCBSRI. These patients may be participating hospital for the member to receive full benefits. Blue Cross & Blue Shield of Rhode Island’s (BCBSRI’s) Medicare Advantage plans are the highest rated in Rhode Island as annual enrollment period begins – we recently received the Centers for Medicare & Medicaid Services’ (CMS’) highest Medicare’s Annual Enrollment Period is now in effect and runs until December 7, for coverage effective January 1, 2023. to accept BCBSRI allowances when treating a BCBSMA member. And when you select a High-Value Provider 2 for your primary care, you get even more. for dental, vision and hearing services above included benefits! • $300/yr for glasses • $0 Part D Drugs** Advocacy / Support • BCBSRI Health Navigator • BCBSRI Medicaid Specialists (e. Any trip over 20 miles will count as additional trips and will be subtracted from your 24 trip total. Attention: Medical Policy, CPT Review. See www. Get easy access to your digital ID card, claim status, and benefit information. This plan uses a provider network. Surgical Procedure Anatomical Modifier. PUBLISHED . Below is a quick overview about how this plan effects providers: All providers participating in the Blue network are included in Lifespan’s coverage. com and click on Benefits. Medicare Telemedicine Reminders; Upcoming live D-SNP training dates; Safe Zone Provider Deadline; Provider data reminders/attestation reminders Flexible Benefit Card, gym membership, and other benefits Start here. ProviderRelations@bcbsri. You shouldn’t have to complete any claims forms or pay up front for medical services other than the usual out-of-pocket expenses (deductibles, copayment, coinsurance and non-covered services). This plan offers a Point-of-Service benefit meaning you can use providers outside the plan’s network for an additional cost on some services. Jul 1, 2024. Larger offices can continue to submit through their clearing houses. Flexible Benefit Card, gym membership, and other benefits BCBSRI is updating its behavioral health fee schedules for Commercial and Medicare Advantage products for dates of service occurring on or after December 1, 2024. org Monday – Friday, 8:00 a. Providence, Rhode Island 02903. This seminar will provide an overview of the following programs and benefits: • Behavioral health • Case management The actual amount you owe is usually less when your providers are in the BCBSRI network. Providers are tiered and can find their tier status by using the BCBSRI Provider Finder. I have privileges at: Primary Hospital Name Effective Date Additional(s) Hospital Name Effective Date . (401) 274-4848 WWW. Including CPT Codes 90867, 90868 and 90869. BCBSRI use of Provider Performance Data for Healthcare Operations. If you need assistance adding your provider to your BCBSRI. 3. Flexible Benefit Card, gym membership, and other benefits Start here Dental provider portal This site is your central resource with information like patient eligibility, claims status, and payments. Get more from your OTC benefit and shop around. o Will BCBSRI support Medicaid recertification? Medicare Advantage See all your options, compare plans, and enroll. Overview; Shop; Why choose BCBSRI? Shop plans. Methadone maintenance. A: BCBSRI covers and separately reimburses for code E0445 when billed/provided by a professional provider e. BCBSRI Update PBF PBF Provider Relations Seminars: June 2017 New! Your Blue Store in East Providence Please join us in June to learn about new and ongoing BCBSRI programs available to your patients. You can find the BCBSRI Doctors Online app in your favorite app store or visit Drs-Online. 500 EXCHANGE STREET, PROVIDENCE, RI 02903-2699 MEDICAL COVERAGE POLICY | 3 (401) 274-4848 WWW. BCBSRI Provider Portal: Use the Eligibility Search by Member ID in the Patient Eligibility A BCBSRI EDI trading partner is any business partner (provider, billing service, software vendor, employer group, financial institution, etc. Required to meet annual. ” Only about 15% of members entered Stage 2 in 2022. Benefits may vary between groups/contracts. With a single log-in or phone call, you can access health and wellness apps, plan information, care management, and customer service—and get personalized health support from Care Guides, nurses, and coaches. When you see a provider in the BCBSRI network, the checkup is covered at no additional cost to you. more. Blue Cross & Blue Shield of Rhode Island’s (BCBSRI’s) Medicare Advantage plans are the highest rated in Rhode Island as annual enrollment period begins – we recently received the Centers for Medicare & Medicaid Services’ (CMS’) highest BCBSRI invites providers to join us on Tuesday, November 14, 2023 from 10-11 a. You pay these amounts each benefit period until you BCBSRI is committed to improving health equity for our members and the healthcare system. Care Team and Medicaid Benefit Coordination. The hospital discharge planner will help coordinate this benefit. If you have any questions related to these changes, please contact our Physician & Provider service center at (401) 274-4848 or 1-800-230-9050 for out-of-state providers. Beginning January 1, 2025, BCBSRI requires that participating providers who treat or diagnose patien P F . Provider Update, March 2020 . Paper claims. BCBSRI invites providers to join us on Tuesday, February 13, 2024 from 10-11 a. Watch and learn about these plans As a result, effective April 1, 2021, the drugs listed below will move from the specialty pharmacy benefit to the medical benefit. Or you may email ProviderRelations@bcbsri. Headway will join BCBSRI’s network as a virtual provider group that delivers quality mental health care to both children and adults by connecting members with providers quickly and efficiently. Database. The vision hardware allowance is available as part of the overall Medicare Advantage plan and the BCBSRI identification card serves as identification of the vision hardware allowance. If you do exceed the Stage 1 coverage limit, your benefit would enter the Stage 2 coverage gap, otherwise known as the “donut hole. O. 2 Unused benefits do not roll over to the next benefit period. Using secure messaging, you can ask questions about: Eligibility/prior authorization/benefits – For Rhode Island members only New: The benefit limit is $1,500 per hearing aid per occurrence. Overview; Shop; Why choose BCBSRI? Insurance basics; Insurance through an employer? Events; BCBSRI Provider Transparency. Additional Benefits. A national program that offers members traveling or living outside of their Blue plan's area the preferred provider organization (PPO) level of benefits when they obtain services from a physician or hospital designated as a BlueCard PPO provider. We are currently beginning the pilot stage of our testing and are hoping to go live for all providers in January of 2024. com by following these easy steps: 1. Access claims, review benefits, and connect directly with BCBSRI customer service—with one easy log-in. BCBSRI offers our Medicare Advantage members a meal delivery program through ILS Meals by Independent Living Systems. Behavioral Health Authorization Request Form 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. Providers must give BCBSRI a 60-day notification of any provider or practice changes. ) And if you're like 85% of BCBSRI Medicare Advantage members in 2022, you won't reach that limit, remaining in Stage 1 all year. Mail: Blue Cross & Blue Shield of Rhode Island. Radiation therapy benefit change. org prior to the meeting. If you provide services to a member which are determined to not be medically necessary (or in some BlueRI for Duals provides additional benefits and supports to both members and providers. Methadone Maintenance. com. 500 EXCHANGE STREET, PROVIDENCE, RI 02903-2699 MEDICAL COVERAGE POLICY | 2 (401) 274-4848 WWW. If you provide Understanding your benefits Provisions $1,500– annual maximum per member $0 deductible per individual plan $0 deductible per family plan Dependents covered until age 26 When you visit out-of-network Payment to the provider will be based on your plan’s reimbursement allowance, less any applicable coinsurance and/or deductible. BCBSRI has enhanced our 2023 Medicare Advantage plans by making them even more comprehensive, Click here for a Provider Identification Number (PIN). Upon completion of the form, your PIN will be emailed to you. In the pilot, primary care providers (PCPs) receive support from BCBSRI to identify and BCBSRI invites providers to join us on Tuesday, March 12 from 10-11 a. Plan Benefits. As a reminder, there is a functionality on the BCBSRI Provider Portal that allows providers to send inquiries via secure messaging. Telemedicine ; 2024 Updates; Upcoming live D-SNP training dates; Provider data; We encourage you to submit any questions you would like addressed If you are a Preferred Provider Organization (PPO) member, the doctor will recognize the PPO Suitcase logo, which will ensure you will get the PPO level of benefits. BCBSRI would like to thank our Residential Treatment Provider partners for their willingness 1 The out-of-pocket maximum includes only Medicare-covered services. If you have any additional questions about these changes or webinar registration, please contact Provider Relations at 1-844-707-5627 or ProviderRelations@bcbsri. If you have a health savings account (HSA), you can manage it too. Coordinate with D-SNP Care Team, care plans and annual ICT meetings Leverage plan benefits and team members to maximize patient supports Meet the Team – know who to contact when. Medicare approved Blue Cross & Blue Shield of Rhode Island to provide these benefits and lower copayments as part of the Value-Based Insurance Design program. In the BCBSRI MHK Provider Portal, providers will now have the ability to add a six-digit extension to their contact phone number. ; Extra Help Plans Medicare + Medicaid and the new Access plans. 1 Available within our service area for HMO & HMO-POS plans only/PPO plan has out-of-service benefit of 50% coinsurance/trip. BlueRI for Duals Provider FAQ BlueRI For Duals, Quick Facts Link to BlueRI for Duals 2024 Flyer: BMED-962947_2024_Duals_(DSNP)_Prospect_Flier_FA2. The web administrator for your practice should follow their New: The benefit limit is $1,500 per hearing aid per occurrence. nqjcj wkvyf dmfgkl dwc xvxqa sqtskh vkbh onald lppo zdjilf