Bcbsri provider benefits form pdf. provider to Nations Benefit at 877 -391- 9637.


  • Bcbsri provider benefits form pdf 0 2 Disclosure Statement . View PDF. At this time BCBSRI does not require non-skilled home care agencies to be Medicare certified. Or you may email ProviderRelations@bcbsri. 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. 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. com or by calling the Provider Service Center at 401-274-4848 or 1-800-230-9050. , Plantation, FL 33313. Dec 6, 2018. Complete the Direct Deposit Agreement form located here. 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. Inpatient/Outpatient Authorization Form (Non- Portal Users) General Statement: Providers should verify if the code requested requires prior authorization via . ^Additional Benefits are available to members who have selected a High-Value Provider as their Primary Care Provider. University Drive Plantation, FL 33322 See Oral Nutrition Mandate for Claims Submission Form. 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). May 22, 2019. Thank you for your cooperation. (401) 274-4848 WWW. Michigan providers should attach the completed form to the request in the e-referral system. and type “Primary Care Provider” and search. org if you have any questions BlueRI for Duals. COM PUBLISHED Provider Update, June 2021 Provider Update, November 2020 Provider Update, March 2020 benefits, call the provider call center. Upon outreach you will receive: 1. Any provider removed from the Provider Directory for failure to attest in Q3 of 2024 will receive a notification from BCBSRI. BCBSRI strives to minimize provider disruption, by coordi-nating HEDIS and risk adjustment medical record requests. Required to meet annual. You will pay less if you use a provider in the plan’s network. authorization form can be faxed to 1-855-212-8110. the QR code is scanned, it will take the member or provide to fepblue. 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 . Acute inpatient hospital assessment form – Blue Cross and BCN commercial. • 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. 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. But we understand that Check claims status and patient eligibility, view remittances, and review the Provider Administrative Manual. Benefits may vary between groups/contracts. • Provider lookup at bcbsri. COVERAGE . 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. Provider Update, May /June/September 2024 . Radiation Therapy benefit is moving to a 20% coinsurance. Institutional SNPs (ISNPs): Beneficiaries have an actual or expected stay of 90 days or Medicare Advantage See all your options, compare plans, and enroll. W-9 Form 5. page. Charges. • 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. Providers Blue Cross & Blue Shield of Rhode Island 270/271 Eligibility Benefit Inquiry and Response Companion Guide 1. benefits for over 40 years. 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). 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. If you have questions about these verification efforts, please email ProviderRelations@bcbsri. • Verify medical benefits by logging on to BCBSRI's Provider Portal and going to the Patient Eligibility section. 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. If you provide The Federal Employee Plan (FEP) is a health benefit plan offered to all federal employees. COM Benefits may vary between groups/contracts. Type II NPI Form – only applicable when billing with a group with an established type II NPI 6. Jul 3, 2024. See slide above for Provider Portal verification information. Please refer to the appropriate Benefit Booklet, Evidence of Oral Nutrition Mandate (for claims submission form) Medical Necessity . Please refer to the appropriate Benefit Booklet, Evidence of Coverage, or Subscriber Agreement for applicable coverage for benefits/coverage. No special request or patient authorization is needed. walker@bcbsri. 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. High-Value Provider network consists of Care New England, Oak Street Health, and Prospect CharterCARE primary care provider (PCP) groups. Practitioner Change Forms are located on bcbsri. BACKGROUND Practitioner Change Forms are locations at bcbsri. Procedures . 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. • This change will not apply until the coverage is made effective by BCBSRI. These forms are available on BCBSRI. Mandatory data elements: Member information: BCBSRI. All sleep laboratory providers performing sleep testing services must participate and be in good standing with Medicare (401) 274-4848 WWW. 1 training and attestation form can be found here. Contact BCBSRI’s Drug Management vendor , Prime Therapeutics, LLC at 1-844-765-2892. the patient and his or her healthcare providers. Please refer to the appropriate Benefit Booklet, Evidence benefits, call the provider call center. Failing to provide direct contact national provider identifier (NPI) numbers. o What happens if a member loses eligibility? (401) 274-4848 WWW. com UB-04 Form: An electronic format of the CMS-1450 paper claim form that has been in general use since 1993. visiting our web site at BCBSRI. Dec 17, 2019. Forms & resources You will find almost any form you need and answers to your most common questions. If you provide BCBSRI HEALTH PLAN COMPANION GUIDE July 2012 005010 1. Fax We have updated the credentialing form for new providers looking to become participating BCBSRI providers. Email Update Form 8. • Click here to review which of BCBSRI's products require a web-based referral for specialist visits. org for FEP blue focus benefit information Practitioner Change Forms are locations at bcbsri. Three to 10 Form is needed for the effective date of the change. 4. 1. Medicare Advantage See all your options, compare plans, and enroll. CMS-1500 (08-05) FORM MUST BE ATTACHED . 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. The updated form can be found here. provider to Nations Benefit at 877 -391- 9637. Timely filing is 180 days from date of service. listed: Primary Care Provider. If you provide services to a member which are network provider? Yes. Here are some of the options we make available to you: • Every quarter, we directly reach out to provider • Provider lookup at bcbsri. g. 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. See slide above Practitioner Change Forms are locations at bcbsri. COM EFFECTIVE DATE: 02|01|2024 POLICY LAST REVIEWED: 02/15/2023 authorization form can be faxed to 1-855-212-8110. If you have any questions, please email ProviderRelations@bcbsri. EIN Confirmation Letter – only applicable for the providers that have a name/TIN mismatch with the IRS 7. Commercial Products Chiropractic services are covered based on the benefit limit of the applicable members benefit plan. To find a provider’s National Provider ID (NPI): more. Eyelid Thermal Pulsation for the Treatment of Dry Eye Syndrome- Effective 3/1/2025 BCBSRI use of Provider Performance Data for Healthcare Operations. You can also obtain benefit information by (401) 274-4848 WWW. COVERAGE. Acupuncture benefits vary across all Medicare plans. 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. 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. 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. The radiation therapy benefit is moving to a 20% coinsurance. provides beneficiaries with access to Medicare and Medicaid benefits managed under one health plan. 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. Medicare Managed Care Manual. Please enter the NDC or UPC number from the cash register receipt. Training Objectives. BCBSRI. View Practitioner Change Forms are locations at bcbsri. Please list the attached bills. The BCBSRI Your Blue Touch RI mobile app can also be used to find providers in (401) 274-4848 WWW. Chapter 4, Sections 90. 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. For information call the BCBSRI Provider Call Center, at (401) 274-4848. Provider Claims Pre-Treatment Estimates P. 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. We’re asking offices to update the link(s) if they are saved in their favorites, as the old link will no longer work. 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). Jun 22, 2022. Navigation. Non Self-guided Study: Complete the 2025 Provider Attestation form providers, and BCBSRI care team. Provider Update, May/June/September 2024 . 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. COM EFFECTIVE DATE: 01|01|2024 POLICY LAST REVIEWED: 10|18|2023 impacted by benefit limits or the prio r authorization process. BCBSRI encourages healthcare providers in our participating network to collaborate with us in support of the LGBTQ (lesbian, gay, bisexual, transgender, queer) community. If you provide services to a (401) 274-4848 WWW. Summary of Medical Benefits Covered Benefits - See Covered Healthcare Services for additional benefit limits and details. COM. 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. • •Your first and last name • Practice name • Practice location or locations • NPI • Specialty and sub-specialties • Panel status listed: Primary Care Provider. BCBSRI Update network benefit, our allowance for the procedure, and applicable co-pays, co-insurances, and deductibles are applied. • When PDF. 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. Mar 11, 2019. 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. 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. 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. Out of Network Request Form * Refer to “Out of Network Request Form” listed under section, “Coordination of Care” COVERAGE . 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. out-of-network benefits. 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. You can email or fax us a copy of the form to BCBSRI at: Email: 2728Forms@bcbsri. 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 2025 plan benefits; Documents & forms; Find a doctor, dentist, or pharmacy; Flexible Benefit Card & OTC; FitOn Health benefit; View PDF. When With a wide range of coverage and benefits, we have options for all Medicare-eligible Rhode Islanders. org if you are interested in joining the BCBSRI Non-skilled Provider Network. Some forms can be submitted online, and others can be printed and then faxed or mailed to us. 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. 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. com or calling our Customer Service Department at (401) 459-5000 or 1-800-639-2227. 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. 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. 1, 90. 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. 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. 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. ; Medicare Supplement Help cover costs with a Plan 65 option. 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. 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. Please note this information would not be shared outside of BCBSRI. You cannot exceed your benefit amount. Network Providers Non-network Providers (*) Preauthorization may The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. COM EFFECTIVE DATE: 01|03|2024 POLICY LAST REVIEWED: 01|03|2024 Benefits may vary between groups/contracts. ; Extra Help Plans Medicare + Medicaid and the new Access plans. participating BCBSRI provider to admit o n my behalf and therefore wish to terminate my participation with BCBSRI for all lines of business. What information are you looking for? Individuals & Families; 1. The evidence on other types of bariatric surgery procedures is insufficient to form conclusions on the impact on health outcomes. 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. 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. benefits, call the provider call center. 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. 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. • 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. Please refer to your policy for specific benefits. ^Additional Benefits are available to members who have selected a High Value Provider as their Primary Care Provider. Instructions for completing each field of the CMS-1500 (02/12) claim form are listed below. 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. If you have any (401) 274-4848 WWW. Covered acupuncture . com. 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. org . Previous versions. com > Providers > Forms. 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. I hereby authorize BCBSRI and its Medical Director to consult with prior and current associates, administrators, and members of hospital staffs or. PUBLISHED . Practitioner Change Forms are locations at bcbsri. Overview; Shop; Provider Update; Forms; Doula application information; Become a participating provider; D-SNP Training; View PDF. Providers may also collaborate with BCBSRI on medical records requests. By CMS rules, the form must be submitted by the provider that provided the initial diagnosis. Non-Wearable Automatic External Defibrillator Medicare Only: E0617 Orthoses, Upper Extremity: 274-4848 WWW. This plan uses a provider network. o Will BCBSRI support Medicaid recertification? Yes. 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 . 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. The SBC shows you how you and the plan would share the cost for covered health care services. To find a provider’s National Provider ID (NPI): BCBSRI when a provider is no longer going to be practicing for your group. 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. Physician/Provider Signature Date . PRIOR AUTHORIZATION Medicare Advantage Plans and Commercial Products benefits, call the provider call center. Provider Update, July 2023 . Box 986005 P. If you provide services to a member which are determined to not be medically necessary (or in some cases Please contact DSNP. BCBSRI. Jul 8, 2022. Feb 14, 2019. 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. If your plan does not include out-of-network benefits, please see the Network Exceptions form, claim form 2, for separate processing instructions. 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. If any BCBSRI employer groups opt out of this waiver, they will be added to list on the provider portal. org or call your provider relations representative. Out-of-State Plans. Sep 26, 2024. If you need assistance with filling out the form, please feel free to reach out to your Provider Relations Authorization Fax Request Form . This list is current as of July 1, 2024, and is subject to change. Questions@bcbsri. 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. 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. 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. 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 would like to become a BCBSRI LGBTQ Safe Zone certified practice, please contact Susan Walker, provider relations manager, at (401) 459-5381 or susan. NPI number (Does not apply for COVID home tests) Prescription cost $ . Unlisted Form for DME . Routine membership, eligibility, benefit information, and claims status for all BCBSRI department. • Providers who did not attest to their information last quarter, have been excluded from the BCBSRI provider directory- Find a Doctor Tool. 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. Please update the link, as the old link will no longer work. Covered Acupuncture . 500 EXCHANGE STREET, PROVIDENCE, RI 02903-2699 MEDICAL COVERAGE POLICY | 5 (401) 274-4848 WWW. physicians and Durable Medical Equipment providers when medically necessary and ordered by a physician/provider. bcbsri. • For inpatient admissions, the filing limit is 180 days from the date of discharge. 5 i the form back to BCBSRI. If you provide services to a member which are determined to the provider is what should be listed in the online directory. BCBSRI participating providers will be able to obtain their PIN electronically when registering on bcbsri. com or call 1-800-639-2227 or (401) 459-5000 for a list of network providers. EFFECTIVE DATE: 04|01|2003 POLICY LAST REVIEWED: 12|20|2023. 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. Dec 12, 2018. 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. (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. 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. com Provider Portal by clicking here. m. 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. org Provider education, responsibilities, policies and procedures Hours: Monday - Friday, 8:00 a. Submit the form to BCBSRI. In 1993, the current Blue Cross Dental plan was created and ProviderRelations@BCBSRI. 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. behavioral health and pharmacy benefit management (PBM) drugs. BlueLine (401) 272-1590 1-800-327-6712 24/7 How to use BlueLine. 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. Complete a CMS-1500 claim form. Claims will continue to pay based on the date of service even if the location is terminated. Out-of-state: 1-800-676-2583. 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. 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 . EFFECTIVE DATE: 11 |01 2024 POLICY LAST REVIEWED: 01 |03 2024. Balance due $ . We are asking that you submit the completed form for all newly diagnosed members to BCBSRI when you submit the form to Medicare. An introductory meeting invitation to discuss the overview of the non-skilled benefit. Mail: 1801 NW 66 Ave. 4 This policy was written to document correct use of CMS forms. 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. OVERVIEW. This program lets Medicare try new ways to improve Medicare Advantage plans. 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. ProviderRelations@BCBSRI. 0 Introduction . To receive your reimbursement, complete and submit this form. In order to become a participating provider, the following documents are required. You may also submit the required information in your own format. If updates are needed, please fill out and submit the BCBSRI Practitioner Change Form. 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. Medicare Advantage Plan members will be held harmless. 2. 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. Please fill out the form below, along with any other information instructed within the form, and fax it to (401) 272-8885. 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. 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. 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. This is not an appeal. See www. COM COVERAGE Benefits may vary between groups/contracts. COVID-19 home test kit claim itemized pharmacy receipts to the back of this form. Provider Update, January/February 2025 . The NPI is listed towards the bottom of the page, on the left hand side. 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. To ensure prompt payment from BCBSRI, please include as much information as possible. PARTICIPATING DENTIST Please continue to check member benefits to see if their plan now is part of a tiered cost sharing. Back to all medical policies. Since the last time I wrote on this topic in January 2017’s Provider Update, BCBSRI has continued to offer providers opportunities to verify accurate practice information. This 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. PROVIDER ADMINISTRATIVE MANUAL CHAPTER 2– Key Contact List for Physicians/Providers BlueLine (401) 272-1590 or 1-800-327-6712 . claim. O. WINFertility update. The information in My Health Toolkit® can help you understand your health plan benefits. If you ONLY want to see providers who are accepting new patients, use the filter on the left hand menu. 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. Professional providers should submit claims using the CMS-1500 forms and institutional providers should submit claims using the UB-82 form. To find a provider’s National Provider ID (NPI): On the provider results page, click on the provider’s name. 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. Our Medicaid Specialists will assist D-SNP members with the annual recertification process. ) Physician. COM Effective April 1, 2010 for labs: All sleep laboratories must be accredited by the American Academy of Sleep Medicine (AASM). A clear photocopy of the other carrier’s Explanation of Benefits Form is acceptable in place of the original document. Dec 1, 2024. To make it easier to find the forms you use regularly, we’ve put them all in one place. If member has Coordination of Benefits (COB), enter the other insurance information here. 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. org. It does not describe all the parts of the plan or guarantee payment, reimbursement or eligibility of coverage. Mail: Nations Benefits CSS - Reimbursement 1700 N. 4. 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. - 4:30 p. All Practitioner Change Forms can be faxed to 401-459-2099 or emailed to ProvDB@bcbsri. 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. 3. Signed current visiting our Web site at BCBSRI. BCBSRI regularly conducts quarterly fax-based validation and attestation of provider practice information displayed within our Find a Doctor tool. Refer to BCBSRI’s COT Category II Code guide, or see the PCP Quality Incentive Program booklet. MEDICAL CRITERIA Not applicable. 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. 2 Unused benefits do not roll over to the next benefit period. Benefits may vary between groups and contracts. We contact provider offices directly, via fax, to ensure this information is accurate and up-to-date. rmcc apfu unufr wqbulgw dzhbo oegjurm lxam euohuhn fgoxz ikav