Bcbsri provider benefits form online 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. Any trip over 20 miles will count as additional trips and will be subtracted from your 24 trip total. com. Send your PA form to: Cross & Blue Shield of Rhode Island (BCBSRI) online prior authorization tool. com 2025 plan benefits; Documents & forms; Find a doctor, dentist, or pharmacy; Flexible Benefit Card & OTC; Learn more about filing a complaint to Medicare about the quality of care or other services you receive from a Medicare provider. Medicare Advantage plans; Extra Help plans; Medicare Flexible Benefit Card, gym membership, and other benefits Start here. Overview; Shop; Provider Update; Forms; Doula application information; Become a participating provider; D-SNP Training; Please check your answers in the form and try to submit again. We encourage you to submit any questions you would like addressed during the call to ProviderRelationsSeminars@bcbsri. m. Use our online scheduler to pick a time convenient for you. Check out BlueCHiP for Medicare Access. 2025 plan benefits; Documents & forms; Find a doctor, dentist, or pharmacy; Flexible Benefit Card & OTC (HMO-POS) plan offers affordable benefits. 47. 2024 plan benefits; Documents & forms; Find a doctor, dentist, or pharmacy; Flexible Benefit Card & OTC; Silver&Fit® gym benefit; We will soon begin publishing provider race and ethnicity in our Find a Doctor provider directory on bcbsri. com to confirm member coverage prior to rendering services. COM. Sign in to myBCBSRI to look up benefits, view claims, pay premiums, and manage your account. Overview; Shop; Provider Update; Forms; Doula application information; Become a participating provider; D 2025 plan benefits; Documents & forms; Find a doctor, dentist, or pharmacy; Flexible Benefit Card & OTC; FitOn Health benefit; Billing, payments, & claims; Behavioral As part of our ongoing efforts to make high-quality and affordable healthcare available to our members, BCBSRI regularly reviews the list of prescription drugs we cover on 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 With your member ID card, you have access to thousands of providers across the country. The codes included in this booklet are the most commonly used, but are not exhaustive. 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. Members can 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. Medicare Advantage plans; Extra Help plans; Medicare Supplement; FAQ; Provider Update; Forms; Doula application information; Become a participating provider; 1 Available within our service area for HMO & HMO-POS plans only/PPO plan has out-of-service benefit of 50% coinsurance/trip. If you are calling by telephone, please dial (401) 459-5900 and enter conference ID: 553 548 76#. BCBSRI has enhanced our 2023 Medicare Advantage plans by making them even more comprehensive, As a reminder, when filing a claim for an unlisted procedure code, please include the Unlisted Procedure Code Form with complete medical records with your submission. Methadone Maintenance. Effective June 1, 2024, CPT codes 81457-81459 and 81462-81464 (new codes effective Use the Provider Portal. com under Provider Forms. Forms. Send paper claims to: 2025 plan benefits; Documents & forms; Find a doctor, dentist, or pharmacy; Flexible Benefit Card & OTC; FitOn Health benefit; Billing, payments, & claims; BCBSRI invites providers to join us on Tuesday, December 10, 2024 from 10-11 a. For information call the BCBSRI Provider Call Center, at (401) 274-4848. 2024 plan benefits; Documents & forms; Find a doctor, dentist, or pharmacy; Flexible Benefit Card & OTC; Why choose BCBSRI? Shop plans. Mar 1, 2019. COVERAGE . 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 Coming soon BCBSRI will be introducing online web claim submission through bcbsri. I. provides beneficiaries with access to Value Based Benefit (VBB) Incented Copay Drug List. Like $3,000 for dental care $300 for eyeglasses an over-the-counter benefit free grocery delivery. This update will change the Methadone Maintenance benefit to the following: Flexible Benefit Card, gym membership, and other benefits Start here. 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. Fill out the required information & click “Go. These changes do not apply to the Blue CHiP for Medicare programs. Our goal is to enhance your experience by giving you the tools and resources to simplify this process. 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. The 2023 PQIP booklet and future updates can be found on the BCBSRI Provider Portal under Quality > See how BlueRI for Duals (HMO D-SNP) gives you so many extra benefits —at no extra cost to you. Acupuncture benefits vary across all Medicare plans. London Health works collaboratively with BCBSRI to combine the benefits of CDHPs with wellness to lower costs and increase employee engagement. Note: Due to a federal law, Plan 65 Select F is not available to enrollees who become Medicare eligible on or after January 1, 2020. com; reimbursement processing will be under 30 days, with 14 days from submission 2025 plan benefits; Documents & forms; Find a doctor, dentist, or pharmacy; Flexible Benefit Card & OTC; FitOn Health benefit; Billing, payments, & claims; BCBSRI invites providers to join us on Tuesday, February 13, 2024 from 10-11 a. For questions about your coverage, please refer to your subscriber agreement/benefit booklet or call Customer Service at (401) 459-5000 or 1-800-639-2227 (outside RI). COM 2024 Prior Authorization of Procedures We encourage you to submit any questions you would like addressed during the call to ProviderRelationsSeminars@bcbsri. If you are having trouble receiving your PIN, please contact Provider Relations at ProviderRelations@bcbsri. Our Medicaid Specialists will assist D-SNP members with the annual recertification process. 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. If you have a health savings account (HSA), you can manage it too. In addition to provider languages that are currently displayed, the information to be published is The information below is effective as of April 1, 2024 and applies to all commercial BCBSRI products, including all Large Group and Small Group markets. The professional and facility Unlisted Procedure Code forms can be located on the forms section of our provider portal or below: Unlisted Procedure Claim Form for Facilities 2024 plan benefits; Documents & forms; Find a doctor, dentist, or pharmacy; Flexible Benefit Card & OTC; Silver&Fit® gym benefit; Billing, payments, & claims update or withdrawal of this temporary waiver will be communicated to BCBSRI providers via a notice on BCBSRI’s provider website/portal under Alerts and Updates as well as within Flexible Benefit Card, gym membership, and other benefits Start here. Overview; Shop; Provider Update; Forms; Doula application information; Claims. If you have any additional questions after reviewing the information, please contact our 500 exchange street, providence, ri 02903-2699 medical coverage policy | 3 (401) 274-4848 www. com 2025 plan benefits; Documents & forms; Find a doctor, dentist, or pharmacy; Flexible Benefit Card & OTC; Why choose BCBSRI? Network coverage; Pharmacy & prescriptions; What's included in all plans; Your Blue Store; Search for providers. Following the call, we will post We encourage you to submit any questions you would like addressed during the call to ProviderRelationsSeminars@bcbsri. 500 EXCHANGE STREET, PROVIDENCE, RI 02903-2699 MEDICAL COVERAGE POLICY | 2 (401) 274-4848 WWW. If you have questions, please contact our Physician and Provider Service Center: (401) 274-4848 Payment to the provider will be based on your plan’s reimbursement allowance, less any applicable coinsurance and/or deductible. Do not use this form if you or your third It is a drug discount program administered by Prime Therapeutics, LLC, an independent company contracted by BCBSRI to provide pharmacy benefit management services. bcbsri. $60/quarter over-the-counter (OTC) benefit for everyday health items (Flexible Benefit Card) $100 annual wellness reimbursement; $0 fitness benefit; $0 rides; 40 hours/year of household help Medicare Advantage See all your options, compare plans, and enroll. ILS Meals is one of the nation’s largest nutritional providers, delivering high-quality, medically tailored therapeutic meals. Please utilize the following form for the following requests. This feature will 2024 plan benefits; Documents & forms; Find a doctor, dentist, or pharmacy; Flexible Benefit Card & OTC; Silver&Fit® gym benefit; Billing, payments, & claims; Need information about your plan? Beginning January 1, 2025, BCBSRI requires that participating providers, who treat or diagnose patients for substance use disorders or refer Cross & Blue Shield of Rhode Island (BCBSRI) online prior authorization tool. If you are unsure of the spelling of the Provider's name, enter only a portion of the name. In order to register as a BCBSRI Trading Partner and begin testing, it is necessary to complete. Below is a quick overview about how this plan effects providers: All providers participating in the Blue network are included in Lifespan’s coverage. General Statement: Providers should verify benefits and eligibility via BCBSRI. See slide above for Provider Portal verification information. This will allow BCBSRI to establish a provider in our system to support claims adjudication and demonstrate compliance with the BCBSRI administrative policies: • Signed current BCBSRI Participating Provider Agreement ** • W-9 Form ** • Type II NPI Form Flexible Benefit Card, gym membership, and other benefits Start here. org; all other providers should contact Provider Relations at 1-844-707 500 EXCHANGE STREET, PROVIDENCE, RI 02903-2699 MEDICAL COVERAGE POLICY | 5 (401) 274-4848 WWW. This market-leading move is consistent with BCBSRI’s groundbreaking A BCBSRI EDI trading partner is any business partner (provider, billing service, software vendor, employer group, financial institution, etc. Phone: 1-800-772-1213 TTY/TDD for hearing impaired: 1 2024 Medicare Part A deductible = $1,632 per benefit period. Small offices will be able to submit claims directly through bcbsri. Medicare Advantage plans; Extra Help plans; 2024 plan benefits; Documents & forms; Find a doctor, dentist, or pharmacy; Flexible Benefit Card & OTC; Silver&Fit® gym benefit; Billing, payments, & claims We have updated the credentialing form for providers looking to become participating BCBSRI providers. 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. Ask your pharmacy if they participate in MedsYourWay before filling your prescription. g. Our Grievance and Appeals Unit (GAU) has updated the appeals request form and the claims adjustment form. Click here to request a Request a Provider Identification Number (PIN). Prior authorization by mail. Appeals Request Form. TRADING PARTNER REGISTRATION. Be sure to save a copy of your completed form for your records. ) It shows how much your provider will charge you when they send you an actual bill—and how much you saved by using the BCBSRI network. Forgot username? Forgot password? Need to register? How can we The most commonly used forms are available below, including the Application Request and Practitioner Change Forms. Doctors Online gives 2025 plan benefits; Documents & forms; Find a doctor, dentist, or pharmacy; Flexible Benefit Card & OTC; BCBSRI offers our Medicare Advantage members a meal delivery Flexible Benefit Card, gym membership, and other benefits Start here. BCBSRI offers our Medicare Advantage members a meal delivery Radiation therapy benefit change. Fill out the required information & select “Go. provides beneficiaries with access to Medicare and Medicaid benefits managed under one health plan. 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. Pulse oximeters are included as part of this OTC benefit. You may also contact Social Security to inquire about your LIS status or level. 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. COM 52441, 52442 C9739, C9740 (For Institutional Providers Only) With your member ID card, you have access to thousands of providers across the country. Medicare Advantage plans; Extra Help plans; Medicare Supplement; FAQ; Provider Update; Forms; Doula application information; Become a participating provider; Medicare Advantage See all your options, compare plans, and enroll. Medicare Advantage plans; Extra Help plans; Medicare Supplement; FAQ; Provider Update; Forms; Doula application information; Become a participating provider; When you submit prior authorizations electronically, they are seamlessly integrated with your electronic health record system, offering you ePA functionality right in your office. Institutional SNPs (ISNPs): Beneficiaries have an actual or expected stay of 90 days or The purpose of this Blue Cross & Blue Shield of Rhode (BCBSRI) Provider Credentialing and (401) 274-4848 WWW. Last Name. Coming soon! On January 1, BlueCare Connect will replace myBCBSRI. Provider Update, January/February 2025 plan benefits; Documents & forms; Find a doctor, dentist, or pharmacy; Flexible Benefit Card & OTC; FitOn Health benefit; Billing, payments, & claims; 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. o What happens if a member loses eligibility? 2024 plan benefits; Documents & forms; Find a doctor, dentist, or pharmacy; Flexible Benefit Card & OTC; Silver&Fit® gym benefit; Billing, payments, & claims; In the BCBSRI MHK Provider Portal, providers will now have the ability to add a six-digit extension to their contact phone number. COM Breast Implant Removal: 11971, 19328, 19330 Get $1,500/year allowance for dental and hearing (Flexible Benefit Card) Extras. When you log in, view the Document Center on the left side of the You can submit your claim online or through the Blue Cross Blue Shield Global Core mobile app. If you provide services to a member which are determined to not 500 EXCHANGE STREET, PROVIDENCE, RI 02903-2699 MEDICAL COVERAGE POLICY | 6 (401) 274-4848 WWW. Please refer to the Blue Cross Dental Subscriber Plan Forms – Access commonly used BCBSRI forms. When you visit a doctor, lab, or hospital and you have to pay part of the cost, we will send you a Healthcare Services Summary (HSS) in the mail. Send paper claims to: Self-guided Study: Complete the 2025 Provider Attestation form providers, and BCBSRI care team. 1 The out-of-pocket maximum includes only Medicare-covered services. Professional requirements (CMS-1500): - Paper claims, place in box 33b proceeded with the ZZ qualifier • Provider lookup at bcbsri. Plan Documents Cross & Blue Shield of Rhode Island (BCBSRI) online prior authorization tool. 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 1 The out-of-pocket maximum includes only Medicare-covered services. This form must be mailed to our claims department at the following address, which is also listed on the bottom of the claim adjustment form: Blue Cross & Blue Shield of Rhode Island BlueRI for Duals. Benefits Pro Portal & App Members can use the Benefits Pro Portal or App to view benefit information, shop for products, manage their orders, and more. Plan Documents Non-surgical periodontal and periodontal maintenance benefits will show up in the members’ online benefit summary when they qualify to receive those benefits. Using secure messaging, you can ask questions about: Eligibility/prior authorization/benefits – For Rhode Island members only Medicare Advantage See all your options, compare plans, and enroll. As a reminder, when filling out a CMS-1500 form and submitting it to BCBSRI for claims processing, it is necessary to Requests for DME should be obtained via the BCBSRI online prior authorization tool, which is available 274-4848 WWW. We are currently beginning the pilot stage of our testing, and are hoping to go live for all providers in January of 2024. 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 Following the call, we will post a summary of topics covered to our Provider Conference Info page on our secure provider portal. If you have any questions 2024 plan benefits; Documents & forms; Find a doctor, dentist, or pharmacy; Flexible Benefit Card & OTC; Silver&Fit® gym benefit; Billing, payments, & claims; An Excel file We encourage you to submit any questions you would like addressed during the call to ProviderRelationsSeminars@bcbsri. If you provide services to a member which are determined to not Following the call, we will post a summary of topics covered to our Provider Conference Info page on our secure provider portal. Apr 1, 2023. If you provide services to a member which are determined to not $175/year allowance for dental and hearing (Flexible Benefit Card) Extras. ” Upon completion of the form, your PIN will be emailed to you. Routine membership, eligibility, benefit information, and claims status for all BCBSRI Flexible Benefit Card, gym membership, and other benefits Start here. Some of the benefits include: Prior authorization by fax. Please ensure your office is utilizing these new forms effective immediately. No form required—please submit an itemized statement and a receipt instead to BCBSRI. Required to meet annual. Doctors Online is not intended to replace these services and should not be used in those circumstances. 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 Flexible Benefit Card, gym membership, and other benefits Start here. It’s simple to register—have your member ID 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 There are three ways you can search for providers and other healthcare services. P B. The new forms can be found on bcbsri. D. org prior to the meeting. We went back 18 months, to 9/1 Flexible Benefit Card, gym membership, and other benefits Start here. First Name. ; Extra Help Plans Medicare + Medicaid and the new Access plans. ). In it, you’ll find ready-to-use communications to help you promote health plan benefits as well as manage Get easy access to your digital ID card, claim status, and benefit information. Institutional SNPs (ISNPs): Beneficiaries have an actual or expected stay of 90 days or 1. The information below is effective as of October 1, 2024, and applies to all commercial BCBSRI products, including all Large Group and Small Group markets. com: Find a Doctor tool, Find an Eye Doctor link, or member portal • No additional discounts if not in network, but can be reimbursed for allowance by completing reimbursement form that will be located on bcbsri. Some forms can be submitted online, and others can be printed If you are looking to file a health or dental claim, you can do so by logging into My Health Toolkit. Power. Schedule a call BCBSRI offers a convenient self-service tool to submit prior authorizations online through the MHK Provider Portal, instead of calling or faxing your request. Click here for a Provider Identification Number (PIN). Practitioner Change Forms are locations at bcbsri. If you provide services to a member which are determined to not Click here for a Provider Identification Number (PIN). Medicare Advantage plans; Extra Help plans; Medicare Supplement; FAQ; Provider Update; Forms; Doula application information; Become a participating provider; PROVIDENCE, R. COM 2024 Prior Authorization of Procedures 500 EXCHANGE STREET, PROVIDENCE, RI 02903-2699 MEDICAL COVERAGE POLICY | 5 (401) 274-4848 WWW. Medicare Advantage plans; Extra Help plans; Medicare Supplement; FAQ; Provider Update; Forms; Doula application information; Become a participating provider; Social Security programs include retirement benefits, disability benefits, family benefits, survivors' benefits, and benefits for the aged and blind. 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), 2025 plan benefits; Documents & forms; Find a doctor, dentist, or pharmacy; Flexible Benefit Card & OTC; FitOn Health benefit; Billing, payments, & claims; Please attend a provider portal training session. Please update the link, as the old link will no longer work. If you Flexible Benefit Card, gym membership, and other benefits Start here. Covered acupuncture . Please go to MyBenefits. o Will BCBSRI support Medicaid recertification? Yes. The 2023 PQIP booklet and future updates can be found on the BCBSRI Provider Portal under Quality > Following the call, we will post a summary of topics covered to our Provider Conference Info page on our secure provider portal. Privacy Statement · Terms & Conditions. RSVP is required. The Web Administrator for your BCBSRI is committed to improving health equity for our members and the healthcare system. including Per our 2019 Provider Manual, for consumer-driven health (CDH) plans including HSAs, HRAs, and flexible spending accounts (FSAs), BCBSRI does not allow in-network participating providers to require payment for Flexible Benefit Card, gym membership, and other benefits Start here. Doulas participating in-network with BCBSRI gain access to the Provider Portal to: See updates from our Provider Relations team; Review claims status; Check 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. NationsBenefits. If you 1. Each Genomic Sequence Analysis Panels in the Treatment of Solid Organ Neoplasms . Medicare Advantage plans; Extra Help plans; Medicare Supplement; FAQ; Provider Update; Forms; Doula application information; Become a participating provider; 2025 plan benefits; Documents & forms; Find a doctor, dentist, or pharmacy; Flexible Benefit Card & OTC Please note from time to time it may be necessary for our Medical Director or their designee to speak to the provider directly. Get rewarded with wellness You can use our wellness Flexible Benefit Card, gym membership, and other benefits Start here. . Please refer to the appropriate Benefit Booklet, Evidence of (for claims submission form) Medical Necessity . 2024. Once completed please, fax the completed As part of our ongoing efforts to make high-quality and affordable healthcare available to our members, BCBSRI regularly reviews the list of prescription drugs we cover on the commercial formularies. Outpatient providers will be routed to our new MHK tool in September, rather than the current “Clear Coverage” platform. The NationsOTC benefit can be configured on our Flex Card solution or through mail order only, allowing for simplified management and use of benefits. com to order online and find information on your benefits. Following the call, we will post a For certain health issues, you can receive care from your provider over the phone or by video. You can fax the prior authorization form to 1-855-212-8110 . COM Effective April 1, 2010 for labs: All sleep laboratories must be accredited by the American Academy of Sleep Medicine (AASM). The web administrator for your practice should follow their 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 As a reminder, there is a functionality on the BCBSRI Provider Portal that allows providers to send inquiries via secure messaging. To attend the session online, please join using Microsoft Teams. Overview; Shop; Provider Update; Forms; Doula application information; Become a participating provider; Please continue to use your BCBSRI payer ID when submitting electronic claims. Overview; Shop; Why choose BCBSRI? Shop plans. No paper form required—visit Benefit documents like the Summary of Benefits and Coverage (SBC) are available through your group’s online account. If you 2025 plan benefits; Documents & forms; Find a doctor, dentist, or pharmacy; Flexible Benefit Card & OTC; Have your BCBSRI member ID card handy if this is your first visit. Proprietary Laboratory Analyses (PLA) coverage updates PF When you visit a doctor, lab, or hospital and you have to pay part of the cost, we will send you a Healthcare Services Summary (HSS) in the mail. Our goal is to make sure that our members continue to have access to effective medications at the lowest possible cost. PUBLISHED . PROVIDER ADMINISTRATIVE MANUAL CHAPTER 2– Key Contact List for Physicians/Providers BlueLine (401) 272-1590 or 1-800-327-6712 . Following the call, we will post a 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 New: The benefit limit is $1,500 per hearing aid per occurrence. 2025 plan benefits; Documents & forms; Find a doctor, dentist, or pharmacy; Flexible Benefit Card & OTC; Have your BCBSRI member ID card handy if this is your first visit. If you are calling by telephone, please dial (401) 459-5900 and enter conference ID: 905 988 004#. Ask your provider if that is an option for any treatment that you may need. The EFT form is included in the Plan Documents section below. Click on this link to learn more and help members stretch their budgets by maximizing their benefits at pharmacy and provider office visits. Secure messaging is located on the left-hand tool bar once you log in to bcbsri. The options for Clear Coverage will Self-guided Study: Complete the 2025 Provider Attestation form providers, and BCBSRI care team. Starting January 1, 2021, all BlueCHiP for Medicare plans include an over-the-counter (OTC) benefit program enhancement. Medicare Advantage plans; Extra Help plans; Medicare Supplement; FAQ; our system was not updated correctly, and providers/groups were receiving payment for these services. • 1Type the name of a doctor, medical specialty, or procedure into the search bar. com; reimbursement processing will be under 30 days, with 14 days from submission Medicare Advantage See all your options, compare plans, and enroll. Out of Network Request Form . From $165. for a co P B F . If you 2025 plan benefits; Documents & forms; Find a doctor, dentist, or pharmacy; Flexible Benefit Card & OTC; BCBSRI offers our Medicare Advantage members a meal delivery program through ILS Meals by Independent Living Systems. com or by calling the Provider Service Center at 401-274-4848 or 1-800-230-9050 prior to requesting any services . As always, we ask that you verify BCBSRI member benefits and eligibility by logging on to the secure provider portal of bcbsri. 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. BCBSRI has also made other rate adjustments in its fee schedule, both upward and downward, generally following Medicare changes and continuing 2024 plan benefits; Documents & forms; Find a doctor, dentist, or pharmacy; Flexible Benefit Card & OTC; Silver&Fit® gym benefit; Billing, payments, & claims; BCBSRI will require the provider taxonomy code to be submitted on all claims. Find out which doctors and hospitals are part of the extensive Blue Cross network. An additional $100 over-the-counter (OTC) benefit for the 4 th Quarter (October through December) BCBSRI is also making it easier for Medicare Advantage members to access care virtually. Benefits Booklet – Find information about covered healthcare services, benefit limits (e. If you New: The benefit limit is $1,500 per hearing aid per occurrence. Do you or anyone else covered by your Blue Cross health By participating in this service, you’ll have a BCBSRI healthcare professional, including nurses, dietitians, health advocates*, and social workers, who will work to improve communication with Fill in your search criteria below. BCBSRI offers our Medicare Advantage members a meal delivery program through ILS Meals by Independent BCBSRI when a provider is no longer going to be practicing for your group. This update will change the methadone maintenance benefit to the following: 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 There is not enough time for mail, so please complete an application online or call us at (401) 351-2583 (TTY: 711). We’re ready to help. This is the most a member would pay for these services during a calendar year. If you are calling by telephone, please dial (401) 459-5900 and enter conference ID: 870 533 808#. ; Medicare Supplement Help cover costs with a Plan 65 option. For a complete list of covered benefits and exclusions, view Benefits in your online account, as well as Subscriber Agreements, to view your plan benefits and services. Monthly premium. Individuals & Use this form if you already have a policy with BCBSRI and need to add a new dependent (for example, newborn, spouse, etc. $60/quarter over-the-counter (OTC) benefit for everyday health items (Flexible Benefit Card) $100 annual wellness reimbursement; $0 fitness benefit; $0 rides; 40 hours/year of household help Group Activity Report (GAR) Form Use this form to add new dependents to an existing policy, cancel coverage, change plan benefits elections, or transfer subscribers from one group to another within the same account. Submitting CMS-1500 forms with correct alignment . 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. Methadone maintenance. You’ll get a week’s worth of meals delivered to your door—up to four times a year—when you get home from an Attend an in-person or online event. View events calendar. The BCBSRI formulary is divided into five tiers. Does every provider in my group need to take the training and attest? Yes. View our list of drugs Value Based Benefit (VBB) Incented Copay Drug List. 2. benefits, call the provider call center. Some forms can be submitted online, and others can be printed and then faxed or mailed to Check claims status and patient eligibility, view remittances, and review the Provider Administrative Manual. With Doctors Online, members were already able to access 24/7 care for common, non-emergency health issues such as colds, allergies or migraines. In order to become a participating provider, the following documents are required. BCBSRI has dedicated resources to providing additional educational training sessions and we encourage all network providers to take As long as you have access to the bcbsri. If the provider does not attend the training, will BCBSRI follow up? Yes, BCBSRI will follow up with the individual provider after the Q1 deadline. Claim Adjustment Form 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). If you have received a new Benefits Prepaid Card, you must activate your card to use your 2024 benefits. We will mute all lines during the call. 2024 plan benefits; Documents & forms; Find a doctor, dentist, or pharmacy; Flexible Benefit Card & OTC; Silver&Fit® gym benefit; Billing, payments, & claims; BCBSRI requires providers to report the name and the Type 1 National Provider Identifier (NPI) of th P . If you are calling by telephone, please dial (401) 459-5900 and enter conference ID: 713 719 061#. 2 Doctors Online is a telemedicine service provided by American Well®, an independent company that administers Doctors Online on behalf of BCBSRI. New: The benefit limit is $1,500 per hearing aid per occurrence. Once logged in, look under Claims & Authorizations and select File a Claim to get started. If you are sending in a claim retraction, claim correction, or medical record, please use the Physician/Provider Claim Adjustment Request form. Self-guided Study: Complete the 2025 Provider Attestation form providers, and BCBSRI care team. 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 500 exchange street, providence, ri 02903-2699 medical coverage policy | 3 (401) 274-4848 www. Providers are tiered and can find their tier status by using the BCBSRI Provider Finder. Effective June 1, 2019, in addition to BlueCHiP for Medicare, coverage for other BHI models under CPT code 99484 is extended to Commercial products for providers that have submitted a program description and received approval from BCBSRI. Doctors Online is a telemedicine service provided by American Well®, an independent company that administers Doctors Online on behalf of BCBSRI. ” 3. All sleep laboratory providers performing sleep testing services must participate and be in good standing with Medicare Improving member outcomes through world-class financial technology, supplemental benefits management, advanced analytics, and custom outcomes programs. Medicare Advantage plans; Extra Help plans; Medicare Supplement; FAQ; Provider Guidelines for Requesting Point of Service Payment and Maintaining Patient Credit Card Information We encourage you to submit any questions you would like addressed during the call to ProviderRelationsSeminars@bcbsri. Overview; Shop; Why choose BCBSRI? Care from any Medicare provider, anywhere in the United States--without a referral (EFT). Or, on Saturday, December 7, you can submit your application Plan 65 options for HealthMate for Medicare (PPO) members. 2025 plan benefits; Documents & forms; Find a doctor, dentist, or pharmacy; Flexible Benefit Card & OTC; FitOn Health benefit; Billing, payments, & claims; BCBSRI invites providers to join us on Tuesday, February 13, 2024 from 10-11 a. Overview; Shop; Provider Update; Forms; Doula application information; Become a participating Every BCBSRI plan includes 100% in-network coverage for your annual physical, flu shot, and recommended tests and screenings. Benefits may vary between groups/contracts. Medicare Advantage See all your options, compare plans, and enroll. You can also download and complete an international claim form and send it to the Blue Cross Thanks for using Web Claims. The radiation therapy benefit is moving to a 20% coinsurance. Services such as dental services rendered in the outpatient setting will not be authorized by this system. Provider Update; Forms; Doula application information; Become a participating provider; BCBSRI members rated us #1 in member satisfaction among commercial health plans in the Northeast region - J. Understanding and meeting the linguistic needs of our members is a shared concern of BCBSRI and our contracted providers. A few highlights of your plan: $0 for many preventive services, such as your annual physical, when you see a network provider; Predictable copays for many services; Lower costs for seeing in-network providers; Access to an extensive national network; View We encourage you to submit any questions you would like addressed during the call to ProviderRelationsSeminars@bcbsri. To make it easier to find the forms you use regularly, we’ve put them all in one place. Please note this information would not be shared outside of BCBSRI. Or you may email ProviderRelations@bcbsri. ) who transmits to or receives electronic data from BCBSRI. org for assistance. COM 52441, 52442 C9739, C9740 (For Institutional Providers Only) Medicare’s Annual Enrollment Period is now in effect and runs until December 7, for coverage effective January 1, 2023. Please see the back page for further instructions. org. HealthMate for Medicare (PPO) will be discontinued after December 31, 2024, so you will need to choose a new plan for 2025. If you have 150 providers in your group, all 150 will need to take the training and fill out the attestation form. Effective January 1, 2020, BCBSRI will become the insurer for all Lifespan employees. (June 27, 2024) — As part of its continuing commitment to support healthcare practitioners and streamline patient access to care, Blue Cross & Blue Shield of Rhode Island (BCBSRI) will eliminate nearly 65% of prior authorization requirements for primary care providers (PCPs) by early 2025. 2025 plan benefits; Documents & forms; Find a doctor, dentist, or pharmacy; Flexible Benefit Card & OTC; FitOn Health benefit; Billing, payments, & claims; BCBSRI invites providers to join us on Tuesday, December 10, 2024 from 10-11 a. All Practitioner Change Forms can be faxed to 401-459-2099 or emailed to ProvDB@bcbsri. Year Training Completed For. Previously limited to four digits, this extension BCBSRI’s PQIP booklet contains acceptable codes for each of the PQIP measures. Medicare Advantage plans; Extra Help plans; In ongoing efforts to increase access to behavioral health providers for our members, BCBSRI has partnered with Doctors Online to provide behavioral health visits via New: The benefit limit is $1,500 per hearing aid per occurrence. Please refer to the individual policies on the web. $160/month for groceries and over-the-counter (OTC) benefit for everyday health items (Flexible Benefit Card) $200 annual wellness reimbursement; $0 fitness benefit; 72 one-way rides/year; 120 hours/year of household help Medicare Advantage See all your options, compare plans, and enroll. Learn about this year’s plans, hear what other people are asking about, and get your own questions answered. Medicare Advantage plans; Extra Help plans; Medicare Supplement; FAQ; Provider Update; Forms; Doula application information; Become a participating provider; • Provider lookup at bcbsri. (Some insurance companies call it an Explanation of Benefits. 1 Blue Cross & Blue Shield of Rhode Island (BCBSRI) Advanced Primary Care Program Policies Effective 7/01/2019 The following program policies are applicable to all contracted providers and 500 EXCHANGE STREET, PROVIDENCE, RI 02903-2699 MEDICAL COVERAGE POLICY | 3 (401) 274-4848 WWW. BCBSRI would like to thank our Residential Treatment Provider partners Flexible Benefit Card, gym membership, and other benefits Start here. Con BlueRI for Duals (HMO D-SNP), no solo obtendrá todos los beneficios de la Parte A y la Parte B por $0, sino que obtendrá más extras. 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), Cross & Blue Shield of Rhode Island (BCBSRI) online prior authorization tool. If you have questions, or encounter any issues with simply provide us with a completed Practitioner Change Form, along with a W-9, Please contact the BCBSRI Provider Relations We encourage you to submit any questions you would like addressed during the call to ProviderRelationsSeminars@bcbsri. 22. Log in now. If you have any Flexible Benefit Card, gym membership, and other benefits Start here. Larger offices can continue to submit through their clearing 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). If you provide services to a member which are determined to not be medically necessary (or in some cases BCBSRI’s PQIP booklet contains acceptable codes for each of the PQIP measures. Schedule a phone call. com > Providers > Forms. See the "Claims" tab on the Medical page for submission instructions. PCPs who have any questions regarding this product can contact pcprequests@bcbsri. 2024 Medicare Part B deductible = $240 per calendar year. And when you select a High-Value Provider 2 for your primary care, you get even more. You can also click the links below to get the forms. BCBSRI. See full text of this policy here. How to enroll. If you 2024 plan benefits; Documents & forms; Find a doctor, dentist, or pharmacy; Flexible Benefit Card & OTC 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. Training Objectives. Flexible Benefit Card, gym membership, and other benefits Start here. You must receive all $175/year allowance for dental and hearing (Flexible Benefit Card) Extras. 3. copayments, deductibles, coinsurance), and The Blue Cross & Blue Shield of Rhode Island (BCBSRI) Employer Toolkit can help. To join the session online, please join using Microsoft Teams. Schedule a call New: The benefit limit is $1,500 per hearing aid per occurrence. If you See how BlueRI for Duals (HMO D-SNP) gives you so many extra benefits —at no extra cost to you. Radiation therapy benefit change. Following the call, we will post a summary of topics covered to our Provider Conference Info page on our secure provider portal. Attend an in-person or online event. Therefore, we would like to inform you that there is a new language resource available to you on the BCBSRI provider portal. • Use the ‘Common Is this for me? If you purchase your health insurance through your employer, this section will show you how to make the most of your plan, from benefits to extra perks. Medicare Advantage plans; Extra Help plans; Medicare Supplement; FAQ; Provider Update; Forms; Doula application information; Become a participating provider; Flexible Benefit Card, gym membership, and other benefits Start here. 23. A few highlights of your plan: $0 for many preventive services, such as your annual physical, when 2024 plan benefits; Documents & forms; Find a doctor, dentist, or pharmacy; Flexible Benefit Card & OTC; Silver&Fit® gym benefit; Billing, payments, & claims; The full The new preauthorization process is now powered by Altruista Health, a best-in-class system focused on streamlining provider workflow. Failing to provide direct contact In the case of an emergency, you should always call 911. Upon completion of the form, your PIN will be emailed to you. Other updates . The web administrator for your practice should follow their We encourage you to submit any questions you would like addressed during the call to ProviderRelationsSeminars@bcbsri. Paper claims. If you already have a Benefits Prepaid Card, you can keep using your current card for all your 2024 spending allowances. COM • EFT Form with cancelled check benefits, call the provider call center. skmv dcptl zuhxwl lghw uocmgh yduyp frjcma scvayb iawqre aaiml
Bcbsri provider benefits form online. Fill out the required information & click “Go.
