Bcbsri provider benefits Nov 1, 2022 · Medicare’s Annual Enrollment Period is now in effect and runs until December 7, for coverage effective January 1, 2023. Mail: Blue Cross & Blue Shield of Rhode Island. 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 Providers and doctors call these Blue Cross & Blue Shield Rhode Island phone numbers for eligibility and other questions. Please follow your FEP guidelines. Flexible Benefit Card, Providers. Care from any Medicare provider, anywhere in the United States--without a referral Flexible Benefit Card, Providers. For information call the BCBSRI Provider Call Center, at (401) 274-4848. Nov 1, 2024 · Effective January 1, 2025, BCBSRI will be removing the non-skilled benefit for all Medicare Advantage plans except BlueRI for Duals (D-SNP). COM. All trademarks unless otherwise noted are the property of Blue Cross & Blue Shield of Rhode Island or the Blue Cross and Blue Shield Association. All PCP visits (including sick visits) will now have a $0 copay for dates of services on or after January 1, 2025. D-SNP Training | Blue Cross & Blue Shield of Rhode Island (bcbsri. POLICY LAST REVIEWED:01 |03 2024. EFFECTIVE DATE: 01 |01 2025 . m. org Dec 1, 2024 · Medicare Advantage See all your options, compare plans, and enroll. com: PowerPoint Presentation (bcbsri. Care Management at your PCMH is offered at no additional cost through your BCBSRI plan. Attention: Medical Policy, CPT Review. Non-network Provider Services 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. OVERVIEW . Medicare approved Blue Cross & Blue Shield of Rhode Island to provide these benefits and lower co-payments as part of the Value-Based Insurance Design program. Self-led instruction on bcbsri. org If your primary care provider is part of a patient-centered medical home (PCMH), a BCBSRI Care Manager will refer you to the Care Manager at your PCMH. (401) 274-4848 WWW. The member belongs to the Federal Employee Program (FEP). Overview; Policies and coverage Blue Cross & Blue Shield of Rhode Island is an independent licensee of the Blue Cross and Nov 1, 2024 · Radiation therapy benefit change. o Will BCBSRI support Medicaid recertification? Yes. Flexible Benefit Card, Prosthetics Providers. We encourage you to submit any questions you would like addressed during the call to ProviderRelationsSeminars@bcbsri. o What happens if a member loses eligibility? Oct 1, 2024 · 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. Flexible Benefit Card, gym Director or their designee to speak to the provider directly. Please refer to your policy for specific benefits. X. 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. for a conference call with the Provider Relations team, who will provide updates and reminders on important topics and changes for 2025. 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. Access provider publications including: Participating Provider Administrative Manual; BCBSRI Practice Guidelines; Orientation visits Dec 1, 2024 · PCP $0 cost sharing. org Personalized Trainings: Kathleen. Physician and Provider Call Center After the out-of-pocket is met, in-network covered services are paid at 100% by Blue Cross & Blue Shield of Rhode Island. The radiation therapy benefit is moving to a 20% coinsurance. Non-Discrimination Statement and Foreign Language Access Network Provider Services If you receive covered healthcare services from a network provider, the provider has agreed to accept our payment for covered healthcare services as payment in full, excluding your copayments, deductible (if any), and the difference between the benefit limit and our allowance, if any. Overview; Policies and coverage Blue Cross & Blue Shield of Rhode Island is an independent licensee of the Blue Cross and Flexible Benefit Card, 2024 Participating Dental Provider Administrative Manual Blue Cross & Blue Shield of Rhode Island is an independent licensee of the The benefits are excluded from the BlueCard program (e. Plan Select G has all of the plan benefits of Plan G and is a great option if you use our Select network of hospitals for inpatient hospital stays. 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 Star rating possible – 5 Requests for authorization of genetic testing should be submitted via the BCBSRI online prior authorization tool, which is available to BCBSRI-participating providers. g. Enrollment in Blue Cross & Blue Shield of Rhode Island depends on contract renewal. Printed Materials and Plan Specifics: ProviderRelations@bcbsri. 2 Not available with all plans. 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? All trademarks unless otherwise noted are the property of Blue Cross & Blue Shield of Rhode Island or the Blue Cross and Blue Shield Association. All other providers may fax a prior authorization request to Utilization Management at (401) 272-8885. Check patient eligibility to verify effective dates of coverage, copays, deductibles, and other information. Blue Cross & Blue Shield of Rhode Island is an independent licensee 500 EXCHANGE STREET, PROVIDENCE, RI 02903-2699 MEDICAL COVERAGE POLICY | 2 (401) 274-4848 WWW. ; Medicare Supplement Help cover costs with a Plan 65 option. It does not describe all the parts of the plan or guarantee payment, reimbursement or eligibility of coverage. Blue Cross & Blue Shield of Rhode Island is an HMO and PPO plan with a Medicare contract. Blue Cross & Blue Shield of Rhode Island: BlueSolutions HDHP Coverage for: See below Plan Type: HDHP . Out-of-State Plans. London Health works collaboratively with BCBSRI to combine the benefits of CDHPs with wellness to lower costs and increase employee engagement. Self-guided Study: Complete the 2025 Provider Attestation form CMS Annual Requirement for ALL providers, cannot be delegated. 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. Brokers Blue Cross & Blue Shield of Rhode Island is an independent licensee of the Blue Cross and Blue Shield Flexible Benefit Card, Providers. All Practitioner Change Forms can be faxed to Dec 1, 2024 · Existing and new prior authorization reviews will continue to be handled by our pharmacy benefits manager, Prime Therapeutics. Dec 1, 2024 · Medicare Advantage See all your options, compare plans, and enroll. Dec 1, 2024 · BCBSRI invites providers to join us on Tuesday, December 10, 2024 from 10-11 a. When in doubt, please submit the claim to us electronically or send the paper claim to us at: Blue Cross & Blue Shield of Rhode Island 500 Exchange Street Check status of all claims submitted with your National Provider Identifier (NPI). com) b. You pay these amounts each benefit period until you Nov 12, 2024 · for provider offices to contact BCBSRI when a provider is leaving your practice. BlueRI for Duals (HMO D-SNP) has a network Nov 1, 2024 · Primary care providers (PCPs) accept responsibility for arranging and coordinating the overall healthcare of BCBSRI members. Simon@bcbsri. 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. Overview; Policies and coverage Blue Cross & Blue Shield of Rhode Island is an independent licensee of the Blue Cross and 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. com > Providers > Forms. London Health is an innovative third-party administrator with expertise in administering consumer-directed health plans for employers while helping them lower employee benefit and human resources expenses. for a conference call with the Provider Relations team, who will provide important updates and reminders. COM Provider Update, March 2018 Provider Update, June 2017 500 EXCHANGE STREET, PROVIDENCE, RI 02903-2699 MEDICAL COVERAGE POLICY | 3 (401) 274-4848 WWW. 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. 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. COM PUBLISHED Provider Update, February 2025 Oct 1, 2021 · All trademarks unless otherwise noted are the property of Blue Cross & Blue Shield of Rhode Island or the Blue Cross and Blue Shield Association. Blue Cross & Blue Shield of Rhode Island is an independent licensee of the Blue Cross and Blue Shield Association. com) 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. Nov 18, 2024 · Flexible Benefit Card, Blue Cross & Blue Shield of Rhode Island. The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. Attention: Medical Policy, CPT review Please note that as a participating provider, it is BlueRI for Duals. Acupuncture benefits vary across all Medicare plans. , dental and prescription medications). 1 of 7. Please note that as a participating provider, it is your responsibility to notify members about non-covered services prior to rendering them. You must provide 60 days notice to BCBSRI when a provider is no longer going to be practicing for your group. You also can view a quick summary of benefits below: 2025. Oct 1, 2021 · All trademarks unless otherwise noted are the property of Blue Cross & Blue Shield of Rhode Island or the Blue Cross and Blue Shield Association. For drug specific prior authorization details, please refer to the drug criteria in the provider administered medication criteria section: Prior Authorization (myprime. Dental Direct Basic; Dental Direct Standard; Dental Direct Plus; Dental Direct Elite Dec 10, 2018 · Flexible Benefit Card, Providers. Services such as dental Dec 1, 2024 · 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. Out-of-state: 1-800-676-2583. org. Tiering of ASC/OP hospital cost sharing Dec 1, 2024 · Email: Medical. Let us know what you think. Blue Cross & Blue Shield of Rhode Island is an independent licensee of the Blue Cross Flexible Benefit Card, BCBSRI use of Provider Performance Data for Healthcare Operations Blue Cross & Blue Shield of Rhode Island is an independent licensee The information in My Health Toolkit® can help you understand your health plan benefits. Start here. Training is available via three modes: a. BCBSRI. Nov 1, 2024 · BCBSRI invites our participating providers to join us on Tuesday, November 12 from 10-11 am. You pay these amounts each benefit period until you reach the in-network or out-of-network out-of-pocket maximum. org prior to the meeting All trademarks unless otherwise noted are the property of Blue Cross & Blue Shield of Rhode Island or the Blue Cross and Blue Shield Association. BlueLine (401) 272-1590 1-800-327-6712 24/7 How to use BlueLine. Flexible Benefit Card, Search for providers. Services requiring claims submission A claim must be submitted for all services not included in a capitation compensation arrangement. Practitioner Change Forms are located on bcbsri. A PCP is a physician (MD or DO) who is board-certified or trained in internal medicine, pediatrics, or family medicine. org Personalized Trainings: ProviderRelations@bcbsri. . You'll also have extensive coverage after meeting the Part B deductible for Medicare-approved services. ; Extra Help Plans Medicare + Medicaid and the new Access plans. Our plan covers up to 100 days in a Copays for SNF benefits are based on benefit periods. 1-800-676-2583 24/7. This will be considered a non-covered benefit. 3 days ago · *Premium and benefits displayed are for members who qualify for Extra Help, also known as Low-Income Subsidy. Dec 10, 2024 · All trademarks unless otherwise noted are the property of Blue Cross & Blue Shield of Rhode Island or the Blue Cross and Blue Shield Association. Policy@bcbsri. Doctors Online is a telemedicine service provided by American Well®, an Blue Cross & Blue Shield of Rhode Island may enroll dual-eligibles in BlueRI for Duals (HMO D-SNP) who are a Specified Low-Income Medicare Beneficiary Plus (SLMB Plus), Qualified Medicare Beneficiary Only (QMB Only), Qualified Medicare Beneficiary Plus (QMB Plus), and Full Benefit Dual Eligible (FBDE). 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. 3 days ago · Flexible Benefit Card, Providers. Providence, Rhode Island 02903. MHM03015_PHSA_C BlueSolutions HDHP C-1795_01_V . EFFECTIVE DATE: 03 |01 2025 . Flexible Benefit Card, and review the Provider Administrative Manual. Our Medicaid Specialists will assist D-SNP members with the annual recertification process. 500 Exchange Street. What training/education is required and/or available? MOC provider training (with attestation) is a CMS annual requirement. Services such as dental Oct 1, 2021 · All trademarks unless otherwise noted are the property of Blue Cross & Blue Shield of Rhode Island or the Blue Cross and Blue Shield Association. POLICY LAST REVIEWED:11 |20 2024. Covered acupuncture . Mar 1, 2021 · As a result, effective April 1, 2021, the drugs listed below will move from the specialty pharmacy benefit to the medical benefit. 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. Copays for hospital benefits are based on per admission/per stay. Or you may email ProviderRelations@bcbsri. Referral An order from your primary care provider (PCP) for you to receive care from another doctor, specialist, or medical facility. com) 20. Oct 1, 2024 · Medicare Advantage See all your options, compare plans, and enroll. gqapymyyeffmxyizpiyokxsnixivhbzifznufwxecomseszwdhebl