Bcbsri provider benefits form pdf. Provider Update, May /June/September 2024 .

Bcbsri provider benefits form pdf • This change will not apply until the coverage is made effective by BCBSRI. COM EFFECTIVE DATE: 02|01|2024 POLICY LAST REVIEWED: 02/15/2023 authorization form can be faxed to 1-855-212-8110. benefits, call the provider call center. The SBC shows you how you and the plan would share the cost for covered health care services. Charges. Or you may email ProviderRelations@bcbsri. PUBLISHED . 4. To be considered for benefit payment, you must submit a clean claim (as defined above) within 180 days of This 834 Health Care Benefit Enrollment and Maintenance Companion Guide is designed for use in conjunction with the ANSI ASC X12N 834 ( 005010X220A1) Health Care Benefit Enrollment and Maintenance 5010 Technical Report Type 3 (TR3). provides beneficiaries with access to Medicare and Medicaid benefits managed under one health plan. From there, click the Medical Benefits tab, and then select the appropriate Service Category and Service Type. If you provide services to a member which are determined to not be medically necessary (or in some cases Please contact DSNP. • •Your first and last name • Practice name • Practice location or locations • NPI • Specialty and sub-specialties • Panel status listed: Primary Care Provider. Out-of-State Plans. Providers may also collaborate with BCBSRI on medical records requests. EFFECTIVE DATE: 04|01|2003 POLICY LAST REVIEWED: 12|20|2023. Professional providers should submit claims using the CMS-1500 forms and institutional providers should submit claims using the UB-82 form. If you have questions on the COB form, please call the Physician and Provider Service Center at (401) 274-4848 or 1-800-230-9050. bcbsri. Please list the attached bills. ^Additional Benefits are available to members who have selected a High-Value Provider as their Primary Care Provider. All resources Broker Service Fees Agreement Brochures and Marketing Materials Forms and Other Important Documents HIPAA Documents Summary of Benefits and Coverage (SBCs) Show me 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. Sep 26, 2024. You will pay the most if you use an out-of-network provider, and you might receive a bill from a provider for the difference Medicare Advantage See all your options, compare plans, and enroll. Physician/Provider Signature Date . However, the me mber must meet eligibility criteria member by the facility All professional provider services filed to Blue Cross & Blue Shield of Rhode Island (BCBSRI) must be filed on a CMS-1500 paper claim form or using an electronic format. PARTICIPATING DENTIST Please continue to check member benefits to see if their plan now is part of a tiered cost sharing. Inpatient/Outpatient Authorization Form (Non- Portal Users) General Statement: Providers should verify if the code requested requires prior authorization via . authorization form can be faxed to 1-855-212-8110. Return the completed form, a voided check (a copy is sufficient), or account information on bank institution letterhead to BCBSRI by fax at (401) 459-2099 or email at ProvDB@bcbsri. ProviderRelations@BCBSRI. Unlisted Form for DME . Please update the link, as the old link will no longer work. o What happens if a member loses eligibility? (401) 274-4848 WWW. com or call 1-800-639-2227 or (401) 459-5000 for a list of network providers. Box 986005 P. Fax We have updated the credentialing form for new providers looking to become participating BCBSRI providers. 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. Mandatory data elements: Member information: BCBSRI. If a laboratory provides a laboratory service that has not been authorized, the service will Please refer to the appropriate Benefit Booklet, Evidence of Blastocysts form 5 to 6 days after insemination. This month, we are recapping the new features we’ve If the provider does not request a pre-service organization determination prior to rendering the services, the provider will be liable for the cost of the services. Please refer to the appropriate Benefit Booklet, Evidence benefits, call the provider call center. 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. Dec 6, 2018. listed: Primary Care Provider. COM 52441, 52442 C9739, C9740 (For Institutional Providers Only) To obtain prescription drug preauthorization, the prescribing provider must submit a prescription drug preauthorization request form. Instructions for completing each field of the CMS-1500 (02/12) claim form are listed below. See slide above for Provider Portal verification information. BCBSRI. Out of Network Request Form * Refer to “Out of Network Request Form” listed under section, “Coordination of Care” COVERAGE . University Drive Plantation, FL 33322 See Oral Nutrition Mandate for Claims Submission Form. page. 2 And you can choose with confidence knowing that all of our HMO-POS plans include: $0 PCP visits & preventive services 4 Participation in the BCBSRI Patient Centered Medical Home (PCMH) and System of Care (SOC) value based programs offers both provider and member level benefits, which may include enhanced provider payment and/or Form is needed for the effective date of the change. Non Self-guided Study: Complete the 2025 Provider Attestation form providers, and BCBSRI care team. provider to Nations Benefit at 877 -391- 9637. walker@bcbsri. We are asking that you submit the completed form for all newly diagnosed members to BCBSRI when you submit the form to Medicare. Dec 1, 2024. To find a provider’s National Provider ID (NPI): BCBSRI when a provider is no longer going to be practicing for your group. To access BlueLine: Call (401) 272-1590 or 1-800-327-6712; Follow the instructions for entering your provider number; Press one (1) for benefits or two (2) for claims; Enter the member's identification number Adjustment Request Form, to be completed and submitted with a corrected claim, is available on the provider section of BCBSRI. Our Medicaid Specialists will assist D-SNP members with the annual recertification process. In 1993, the current Blue Cross Dental plan was created and ProviderRelations@BCBSRI. Contact BCBSRI’s Drug Management vendor , Prime Therapeutics, LLC at 1-844-765-2892. If the member has a PPGRI PCP, you will be transferred to 500 exchange street, providence, ri 02903-2699 medical coverage policy | 3 (401) 274-4848 www. , Plantation, FL 33313. • Call the Lifespan Employee CARE Center at (401) 429-2102 or 1-866-987-3706 or visit a Your Blue Store (BCBSRI retail store) to speak with a representative. Any provider removed from the Provider Directory for failure to attest in Q3 of 2024 will receive a notification from BCBSRI. MEDICAL CRITERIA Not applicable. To find a provider’s National Provider ID (NPI): more. If any BCBSRI employer groups opt out of this waiver, they will be added to list on the provider portal. O. Thank you for your cooperation. If you need assistance with filling out the form, please feel free to reach out to your Provider Relations Authorization Fax Request Form . NPI number (Does not apply for COVID home tests) Prescription cost $ . As of today, BCBSRI is not aware of any group outside of the groups that have already opted out of cost share wavier that will NOT be waiving cost share for codes 99211 and 99212 for PCP and BH providers. • When PDF. 5 i the form back to BCBSRI. If you have any (401) 274-4848 WWW. Training Objectives. Providers Blue Cross & Blue Shield of Rhode Island 270/271 Eligibility Benefit Inquiry and Response Companion Guide 1. Mail: Nations Benefits CSS - Reimbursement 1700 N. Previous versions. Requests must include the following: Name, Date of Birth, Member Number, and information BlueLine provides quick and easy access to membership, eligibility, and benefit information, as well as detailed claims status. COM EFFECTIVE DATE: 01|01|2024 POLICY LAST REVIEWED: 10|18|2023 impacted by benefit limits or the prio r authorization process. By signing this form, I acknowledge and agree that: • I understand the medical and dental plan benefits I have selected, including the deductible benefit maximums and out-of-pocket maximums, if applicable. Michigan providers should attach the completed form to the request in the e-referral system. I hereby authorize BCBSRI and its Medical Director to consult with prior and current associates, administrators, and members of hospital staffs or Radiation therapy benefit change. com. PROVIDER ADMINISTRATIVE MANUAL CHAPTER 2– Key Contact List for Physicians/Providers BlueLine (401) 272-1590 or 1-800-327-6712 . Sincerely, Virginia Levi Assistant Vice President Customer and Provider Service A: BCBSRI covers and separately reimburses for code E0445 when billed/provided by a professional provider e. Please refer to the appropriate Benefit Booklet, Evidence of Coverage, or Subscriber Agreement for applicable medical benefits/coverage or for limitations of benefits/coverage when services are not medically necessary. COVERAGE . • For inpatient admissions, the filing limit is 180 days from the date of discharge. the patient and his or her healthcare providers. The evidence on other types of bariatric surgery procedures is insufficient to form conclusions on the impact on health outcomes. 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 General Statement: Providers should verify if the code requested requires prior authorization via BCBSRI. Fax: 401-459-1708 BCBSRI Update PBF As of January 1, 2017, BCBSRI completed the transition of its pharmacy benefits manager (PBM) to Prime Therapeutics, LLC. out-of-network benefits. View Practitioner Change Forms are locations at bcbsri. To ensure prompt payment from BCBSRI, please include as much information as possible. 0 Introduction . In order to become a participating provider, the following documents are required. If you ONLY want to see providers who are accepting new patients, use the filter on the left hand menu. CMS-1500 (08-05) FORM MUST BE ATTACHED . These forms are available on BCBSRI. This list is current as of July 1, 2024, and is subject to change. Routine membership, eligibility, benefit information, and claims status for all BCBSRI department. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires that all health 2025 plan benefits; Documents & forms; Find a doctor, dentist, or pharmacy; Flexible Benefit Card & OTC; BCBSRI Provider Transparency Upload date. Dec 12, 2018. You can email or fax us a copy of the form to BCBSRI at: Email: 2728Forms@bcbsri. and type “Primary Care Provider” and search. COM COVERAGE Benefits may vary between groups/contracts. com or calling our Customer Service Department at (401) 459-5000 or 1-800-639-2227. EFFECTIVE DATE: 11 |01 2024 POLICY LAST REVIEWED: 01 |03 2024. See slide above Practitioner Change Forms are locations at bcbsri. View PDF. 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. By CMS rules, the form must be submitted by the provider that provided the initial diagnosis. It does not describe all the parts of the plan or guarantee payment, reimbursement or eligibility of coverage. Claims will continue to pay based on the date of service even if the location is terminated. If you have any questions about this change, please contact ProviderRelations Online pharmacy directory - most up to date; 2024 PDF version of the pharmacy directory - to print or email; 2024 PDF version of the pharmacy directory - to print or email; You may save money when you use one of these preferred pharmacies; You may save money when you use one of these preferred pharmacies *Please note that the directories are subject to Radiation Therapy benefit change. To obtain benefit and coverage information, please call our Medical Professional Services Department at (401) 274‐4848 or, for out‐of‐state providers, at 1‐800‐230‐9050. We’re asking offices to update the link(s) if they are saved in their favorites, as the old link will no longer work. ADJUSTMENTS CANNOT BE MADE WITHOUT SUPPORTING DOCUMENTATION PROVIDER APPEAL REQUEST FORM Date: _____ Office Contact Person: _____ Phone: (___)_____ Provider Name: _____ Group Name: _____ National Provider Identifier (NPI): _____ Providers and doctors call these Blue Cross & Blue Shield Rhode Island phone numbers for eligibility and other questions. 2. Please refer to the appropriate Benefit Booklet, Evidence of Coverage, or Subscriber Agreement for applicable coverage for benefits/coverage. Feb 14, 2019. COVID-19 home test kit claim itemized pharmacy receipts to the back of this form. g. Jul 3, 2024. Submit the form to BCBSRI. The NPI is listed towards the bottom of the page, on the left hand side. This seminar will provide an overview of the following programs and benefits: • Behavioral health • Case management Medicare Advantage See all your options, compare plans, and enroll. Please refer to your policy for specific benefits. We contact provider offices directly, via fax, to ensure this information is accurate and up-to-date. If you need assistance with filling out the form, please feel free to reach out to your Provider Relations Medicare Advantage See all your options, compare plans, and enroll. But we understand that Check claims status and patient eligibility, view remittances, and review the Provider Administrative Manual. Email Update Form 8. The BCBSRI Your Blue Touch RI mobile app can also be used to find providers in (401) 274-4848 WWW. BCBSRI Update network benefit, our allowance for the procedure, and applicable co-pays, co-insurances, and deductibles are applied. Provider Update, August/October of law or employment, the Explanation of Benefits Form furnished by the other carrier pertaining to these charges must be included with the . • Providers who did not attest to their information last quarter, have been excluded from the BCBSRI provider directory- Find a Doctor Tool. claim. org if you are interested in joining the BCBSRI Non-skilled Provider Network. Refer to BCBSRI’s COT Category II Code guide, or see the PCP Quality Incentive Program booklet. The specifications contained within this Companion Guide define current functions and provide supplemental information specific to Blue You may also call the BCBSRI Physician & Provider Service Center at (401) 274-4848 or 1-800-230-9050. Type II NPI Form – only applicable when billing with a group with an established type II NPI 6. You ca HealthMate Coast-to-Coast Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: See below Plan Type: PPO Questions: Call 1-800-639-2227 or (401) 459-5000 or TDD 1-888-252-5051 or visit us at www. You can also obtain benefit information by (401) 274-4848 WWW. Summary of Medical Benefits Covered Benefits - See Covered Healthcare Services for additional benefit limits and details. • Click here to review which of BCBSRI's products require a web-based referral for specialist visits. PRIOR AUTHORIZATION Medicare Advantage Plans and Commercial Products benefits, call the provider call center. The correct benefit information is as follows: • Medicare members who see their PCP or Behavioral Health Specialist for Telemedicine, the member will have a Practitioner Change Forms are located on bcbsri. Chapter 4, Sections 90. Overview; Shop; Provider Update; Forms; Doula application information; Become a participating provider; D-SNP Training; View PDF. physicians and Durable Medical Equipment providers when medically necessary and ordered by a physician/provider. Acute inpatient hospital assessment form – Blue Cross and BCN commercial. Required to meet annual. W-9 Form 5. This new, more efficient process eliminates the need to mail or fax a signed form and will allow providers to receive their PIN immediately via email once they complete a few easy steps online. org or call your provider relations representative. This plan uses a provider network. Mar 11, 2019. If you provide BCBSRI HEALTH PLAN COMPANION GUIDE July 2012 005010 1. No special request or patient authorization is needed. com Provider Portal by clicking here. Practitioner Change Forms are located on bcbsri. If you provide services to a member which are network provider? Yes. • Providers must attest by December 31st (end of Q4) to ensure they BCBSRI when a provider is no longer going to be practicing for your group. BCBSRI 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. org for FEP blue focus benefit information Practitioner Change Forms are locations at bcbsri. If your plan does not include out-of-network benefits, please see the Network Exceptions form, claim form 2, for separate processing instructions. Provider Update, May /June/September 2024 . Q: Are the fees different when using 02 vs 10 place of service codes? meaning are members responsible for copays/cost sharing for both of these based on members plans, etc or do they differ Physician/Provider Appeal Request Form. Reason for Special Handling: The fully-insured BCBSRI, Lifespan Blue or Brown University health plan member identified on the attached CMS-1500 form has exhausted his or her standard outpatient behavioral health benefit maximum and requires additional outpatient treatment. Signed current visiting our Web site at BCBSRI. (401) 274-4848 WWW. Eyelid Thermal Pulsation for the Treatment of Dry Eye Syndrome- Effective 3/1/2025 BCBSRI use of Provider Performance Data for Healthcare Operations. At this time BCBSRI does not require non-skilled home care agencies to be Medicare certified. OVERVIEW. You cannot exceed your benefit amount. If member has Coordination of Benefits (COB), enter the other insurance information here. Medicare Advantage See all your options, compare plans, and enroll. If updates are needed, please fill out and submit the BCBSRI Practitioner Change Form. COM EFFECTIVE DATE: 01|03|2024 POLICY LAST REVIEWED: 01|03|2024 Benefits may vary between groups/contracts. Out-of-state: 1-800-676-2583. com UB-04 Form: An electronic format of the CMS-1450 paper claim form that has been in general use since 1993. Or maybe you’ve come across a healthcare term for the hundredth time and decided you want to know what it really means—check out our Definitions. This feature will show any open authorizations and up to six months of By signing this form, I acknowledge and agree that: • I understand the medical and dental plan benefits I have selected, including the deductible benefit maximums and out-of-pocket maximums, if applicable. ; Extra Help Plans Medicare + Medicaid and the new Access plans. Three to 10 Form is needed for the effective date of the change. - 4:30 p. This means we require BCBSRI-contracted providers to information by completing the form and returning it to us (or their Blue Cross and Blue Shield home plan). com, by calling the number listed for the “Pharmacist” on the back of the members ID card, or the provider can contact the Physician & Provider Service Center. • Verify medical benefits by logging on to BCBSRI's Provider Portal and going to the Patient Eligibility section. For information call the BCBSRI Provider Call Center, at (401) 274-4848. Please refer to the appropriate Benefit Booklet, Evidence of Oral Nutrition Mandate (for claims submission form) Medical Necessity PUBLISHED Provider Update, May/June/September 2024 Provider Update, July 2023 Provider Update, participating BCBSRI provider to admit o n my behalf and therefore wish to terminate my participation with BCBSRI for all lines of business. If you have any questions, please email ProviderRelations@bcbsri. The updated form can be found here. Q: Am I part of the D-SNP product if I am a PCP? You will submit your D-SNP member’s claim to BCBSRI for benefit review and disbarment. Jul 8, 2022. Blue Cross & Blue Shield of Rhode Island (BCBSRI) administers this plan to FEP employees in Rhode Island through the FEP contract with the Blue Cross and Blue Shield Association. Some forms can be submitted online, and others can be printed and then faxed or mailed to us. Covered acupuncture . Institutional SNPs (ISNPs): Beneficiaries have an actual or expected stay of 90 days or Medicare Advantage See all your options, compare plans, and enroll. BACKGROUND Practitioner Change Forms are locations at bcbsri. Procedures . Radiation Therapy benefit is moving to a 20% coinsurance. Since the last time I wrote on this topic in January 2017’s Provider Update, BCBSRI has continued to offer providers opportunities to verify accurate practice information. Questions@bcbsri. 0 2 Disclosure Statement . WINFertility update. Covered Acupuncture . m. If you provide services to a (401) 274-4848 WWW. benefits for over 40 years. Please note this information would not be shared outside of BCBSRI. You may also submit the required information in your own format. BCBSRI. 3. the QR code is scanned, it will take the member or provide to fepblue. org Provider education, responsibilities, policies and procedures Hours: Monday - Friday, 8:00 a. ) Physician. FORMULARY means the prescription drugs and dosage forms covered under this Blue Shield of Rhode Island to provide these benefits and lower co-payments as part of the Value-Based Insurance Design program. Benefits may vary between groups and contracts. This is not an appeal. COM Benefits may vary between groups/contracts. Our goal is to identify environments in which LGBTQ violation of this policy and severe action will be taken up to and including termination from the BCBSRI provider network. See www. You will pay less if you use a provider in the plan’s network. ADJUSTMENTS CANNOT BE MADE WITHOUT SUPPORTING DOCUMENTATION: Please be sure to submit all supporting documentation to: Blue Cross & Blue Shield of Rhode Island Basic Claims Administration – Inquiry Unit – 00066 Physician/Provider Claim Adjustment Request Form Type of claim (check one): ☐ BCBSRI ☐ BlueCard ☐ New England Health Plan (NEHP) the BCBSRI Claims Department can adjust the claim. If you provide services to a member which are determined to the provider is what should be listed in the online directory. 1. visiting our web site at BCBSRI. BCBSRI participating providers will be able to obtain their PIN electronically when registering on bcbsri. As always, we ask that you verify BCBSRI member benefits and eligibility by logging on to the secure provider Practitioner Change Forms are located on bcbsri. BCBSRI regularly conducts quarterly fax-based validation and attestation of provider practice information displayed within our Find a Doctor tool. To find a provider’s National Provider ID (NPI): On the provider results page, click on the provider’s name. To make it easier to find the forms you use regularly, we’ve put them all in one place. When With a wide range of coverage and benefits, we have options for all Medicare-eligible Rhode Islanders. Box 986005 Boston, MA 02298 Boston, MA 02298 As a participating dentist with BCBSRI, you are part of the BCBSMA network, and agree to accept BCBSRI allowances when treating 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. Please fill out the form below, along with any other information instructed within the form, and fax it to (401) 272-8885. • Get a list of your benefits and recent claims • See how much you’ve paid toward your deductible • Use our online Find a Doctor tool to find a qualified dentist of your choice Visit With the Vision Eyewear Program, you can be reimbursed up to a maximum of $150 per member per benefit year * toward the purchase of prescription eyeglasses (lenses and/or frames) and (BCBSRI) for Medicare Advantage Plans members is 180 days from the date of service. This Companion Guide may be revised and republished if and when Blue Cross & Blue Shield of Rhode Island makes improvements and/or changes Medicare Advantage See all your options, compare plans, and enroll. Complete a CMS-1500 claim form. All sleep laboratory providers performing sleep testing services must participate and be in good standing with Medicare (401) 274-4848 WWW. 2024 plan benefits; Documents & forms; Find a doctor, dentist, or pharmacy; Flexible Benefit Card & OTC Provider Guidelines for Requesting Point of Service Payment and Maintaining Patient Credit Card Information View PDF. org if you have any questions BlueRI for Duals. behavioral health and pharmacy benefit management (PBM) drugs. Provider Update, May/June/September 2024 . Provider Update, July 2023 . Forms & resources You will find almost any form you need and answers to your most common questions. Please enter the NDC or UPC number from the cash register receipt. org . Balance due $ . 1, 90. Medicare Managed Care Manual. I hereby authorize BCBSRI and its Medical Director to consult with prior and current associates, administrators, and members of hospital staffs or. The radiation therapy benefit is moving to a 20% coinsurance. If you provide The Federal Employee Plan (FEP) is a health benefit plan offered to all federal employees. Back to all medical policies. com or by calling the Provider Service Center at 401-274-4848 or 1-800-230-9050. Acupuncture benefits vary across all Medicare plans. This program lets Medicare try new ways to improve Medicare Advantage plans. Navigation. Provider Claims Pre-Treatment Estimates P. If you provide services to a member which are determined to not be medically necessary 2025 plan benefits; Documents & forms; Find a doctor, dentist, or pharmacy; Flexible Benefit Card & OTC; FitOn Health benefit; View PDF. 500 EXCHANGE STREET, PROVIDENCE, RI 02903-2699 MEDICAL COVERAGE POLICY | 5 (401) 274-4848 WWW. Services are covered under the member durable medical equipment benefit and the services do not require prior Search for plan descriptions, benefit summaries, forms, and other materials you need. 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. Provider Update, January/February 2025 . Upon outreach you will receive: 1. com > Providers > Forms. An introductory meeting invitation to discuss the overview of the non-skilled benefit. org. If you are a Medicare member, you may use this form or just submit a written Medicare Advantage See all your options, compare plans, and enroll. EIN Confirmation Letter – only applicable for the providers that have a name/TIN mismatch with the IRS 7. Failing to provide direct contact national provider identifier (NPI) numbers. Jun 22, 2022. If Can we save the PowerPoint as a PDF and distribute to all of our providers? And once they review the PDF, they will go in and attest? A: Yes, you If you aren’t clear about any of the bolded terms used in this form, see the Glossary. If you have questions about these verification efforts, please email ProviderRelations@bcbsri. Updates from Provider Relations Review Claims Status Check Member Benefits & Eligibility Review Your Weekly Remittance Attest to Provider Data Quarterly Secure Messaging to Provider Call Center providers using the Find a Doctor tool, available through BCBSRI. Complete the Direct Deposit Agreement form located here. 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 on bcbsri. If you need assistance with filling out the form, please feel free to reach out to your Provider Relations Flexible Benefit Card, gym membership, and other benefits Start here. BlueLine (401) 272-1590 1-800-327-6712 24/7 How to use BlueLine. All Practitioner Change Forms can be faxed to 401-459-2099 or emailed to ProvDB@bcbsri. • Provider lookup at bcbsri. o Will BCBSRI support Medicaid recertification? Yes. May 22, 2019. 4 This policy was written to document correct use of CMS forms. What information are you looking for? Individuals & Families; 1. COM PUBLISHED Provider Update, February 2025 Provider Update, February 2024 Provider Update, October 2022 Provider Update, March 2021 Provider Update, February 2020 REFERENCES Centers for Medicare and Medicaid Services. BCBSRI encourages healthcare providers in our participating network to collaborate with us in support of the LGBTQ (lesbian, gay, bisexual, transgender, queer) community. The information in My Health Toolkit® can help you understand your health plan benefits. COM sufficient to conclude that sleeve gastrectomy has similar or lower short-term complications, with medium- to long-term weight loss that is somewhat less than for gastric bypass. For a list of PCPs participating in your plan: In the “Start your search here” field, click inside the box and type “Primary Care Provider” and search. High-Value Provider network consists of Care New England, Oak Street Health, and Prospect CharterCARE primary care provider (PCP) groups. A clear photocopy of the other carrier’s Explanation of Benefits Form is acceptable in place of the original document. Fax the completed form along with clinical information to Utilization Management at 401-272-8885 Participating with BCBSRI 2 Once you become a participating (in network) Doula provider with BCBSRI, you will be able to gain access to the Provider Portal. Please refer to the appropriate Benefit Booklet, Evidence of Oral Nutrition Mandate (for claims submission form) Medical Necessity . FORMULARY means the prescription drugs and dosage forms covered under this Page 3 of 9 Dental Benefits Included in Medical Plan Monthly Premium $0 $0 Calendar Year Coverage Limit $1,500 $1,500 Preventive Services Covered at 100% Covered at 100% Comprehensive Services Covered at 100% Covered at 100% Medical and Prescription Drug Plans Medical Only BlueCHiP for Medicare Provider Update; Forms; Doula application information; Become a participating provider; D-SNP Training; LGBTQ+ Safe Zone Program; Contacts; FAQ Effective January 1, 2025, BCBSRI will remove the non-skilled benefit for all Medicare Advantage pla P F . To receive your reimbursement, complete and submit this form. COVERAGE. participating BCBSRI provider to admit o n my behalf and therefore wish to terminate my participation with BCBSRI for all lines of business. 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 (401) 274-4848 WWW. Over the last several months, we’ve shared information in each issue of Provider Update to help our provider community become more familiar with Prime. Network Providers Non-network Providers (*) Preauthorization may The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. Manage Your Plan; Prescription Drugs; Find Care; See Plan Perks; Live Healthy Provider Update; Forms; Doula application information; Become a participating provider; (if you’re not a BCBSRI member yet) If so, we can help you make the most of your benefits—and possibly save you money! Simply complete this form and mail to: Attn: OCL Department (A) - 00119 Blue Cross & Blue Shield of Rhode Island benefit management (PBM) drugs, and Fully insured Infertility services. n view the Glossary 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. 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. If you need assistance with filling out the form, please feel free to reach out to your Provider Relations A: There is not an extension at this time. This process typically takes two to three weeks, providing we receive all necessary To obtain prescription drug preauthorization, the prescribing provider must submit a prescription drug preauthorization request form. Provider Update, July 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 Supplement Help cover costs with a Plan 65 option. com; reimbursement processing will be under 30 days, with 14 days from submission to payment on average 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. Mail: 1801 NW 66 Ave. Timely filing is 180 days from date of service. com; reimbursement processing will be under 30 days, with 14 days from submission 500 EXCHANGE STREET, PROVIDENCE, RI 02903-2699 MEDICAL COVERAGE POLICY | 6 (401) 274-4848 WWW. ^Additional Benefits are available to members who have selected a High Value Provider as their Primary Care Provider. BCBSRI strives to minimize provider disruption, by coordi-nating HEDIS and risk adjustment medical record requests. 1 training and attestation form can be found here. COM. 2 Unused benefits do not roll over to the next benefit period. Medicare Advantage Plan members will be held harmless. Non-Wearable Automatic External Defibrillator Medicare Only: E0617 Orthoses, Upper Extremity: 274-4848 WWW. If you provide 2025 plan benefits; Documents & forms; Find a doctor, dentist, or pharmacy; Flexible Benefit Card & OTC; 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. THIS FORM DOES NOT APPLY when submitting a corrected claim / claim adjustment, such as: o Other carrier EOB within 180 days of retraction o Corrected claim within 180 days of denial disposition o Corrected claim within 18 months of paid dispositions (Commercial only) o Claim not on file Sign into your BCBSRI. The dental benefits included in our Medicare Advantage plans are considered supplemental benefits and are simply provide us with a completed Practitioner Change Form, along with a W-9, Please contact the BCBSRI Provider Relations team at . Members may submit a claim form for reimbursement along with the original printed, itemized receipt from the provider to Nations Benefit at 877-391- 9637. If you do not have a BCBSRI account, We do not currently have the capability to submit a UB04 form on the web and FEP members are out of scope as well for this process. 4. Dec 17, 2019. COM PUBLISHED Provider Update, June 2021 Provider Update, November 2020 Provider Update, March 2020 benefits, call the provider call center. (There are Healthcare benefit programs issued or administered by Capital Blue Cross and/or its subsidiaries, Capital Advantage Insurance Company®, Capital Advantage Assurance Company® and Helpful forms Choosing your plan (if you’re not a BCBSRI member yet) The easiest way to enroll in our health and dental plans is using our simple shopping tool online. Commercial Products Chiropractic services are covered based on the benefit limit of the applicable members benefit plan. COM Effective April 1, 2010 for labs: All sleep laboratories must be accredited by the American Academy of Sleep Medicine (AASM). Here are some of the options we make available to you: • Every quarter, we directly reach out to provider • Provider lookup at bcbsri. All professional provider services filed to Blue Cross & Blue Shield of Rhode Island (BCBSRI) must be filed on a CMS-1500 paper claim form or using an electronic format. Benefits may vary between groups/contracts. Practitioner Change Forms are locations at bcbsri. ivd hjme gdydo pfgr sbbhhq fkhum qmqqm lvmf wnxw ojpgepa