Bcbsri com providers phone number. BCBSRI does not Credential Groups.

Bcbsri com providers phone number Provider Finder Search: Before you begin your search, please note: We update our provider listings frequently, but our networks change constantly. • Send secure messages to our Physician & Provider Call Center team instead of calling . This includes services such as durable Email: Medical. The notice shall be sent by certified mail, return receipt requested, postage prepaid. In addition to provider languages that are currently displayed, the information to be published is obtained from the provider’s entry via the voluntary disclosure on the Council for Affordable Quality HealthCare (CAQH) database. The program runs through your online member account and is also available on your phone—at no If you already have dental coverage with BCBSRI, you can find everything you need to know about your plan, including covered services and claims, through the Dental Benefits section of your online account. 1/1/2024 Updates for provider offices to contact BCBSRI when a provider is leaving your practice. Q: As a BCBSRI provider seeing BlueChip for Medicare How do you find BlueCHiP for Medicare’s providers in your area? You may look up a provider by last name in the alphabetical physician/provider listing starting on Page 1 of this directory. The codes included in this booklet are the most commonly used, but are not exhaustive. Find providers numbers for claims, correspondence, managed care and traditional products and more Contact audience. The Centers for Medicare & Medicaid Services (CMS) requires providers to note whether the location You can still submit your Medicare application, however, the application must be received by Saturday, December 7. You also can view a quick summary of benefits below: 2025. And mark your calendar for our next conference call on Tuesday, January 9, 2024. Blue Cross and Blue Shield Medicare is federal health insurance for eligible people 65+ or with certain medical conditions. Once you become a participating (in network) Doula provider with BCBSRI, you will be able to gain access to the Provider Portal. You don’t have to do it alone. N/A. 2273. Please note that as a participating provider, it is your responsibility to notify members about non-covered services prior to rendering them. 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. org ; all other providers should contact Provider Relations at 1-844-707 For any other provider inquiries not associated with this training, please email ClientServices@evicore. to 4:30 p. PROVIDER ADMINISTRATIVE MANUAL CHAPTER 2– Key Contact List for Physicians/Providers BlueLine (401) 272-1590 or 1-800-327-6712 . PEBA; BlueCross BlueShield of South Carolina; Press Room; Contact Us; Assistance. 1. Providers and doctors call these Blue Cross & Blue Shield Rhode Island phone numbers for eligibility and other questions. A specific customer service center supports each member. ; Extra Help Plans Medicare + Medicaid and the new Access plans. Get rewarded with wellness You can use our wellness program online or on your phone to help you feel better, have fun, Medicare Advantage See all your options, compare plans, and enroll. As a reminder, there is a functionality on the BCBSRI Provider Portal that allows providers to send inquiries via secure messaging. Surgical Procedure Anatomical Modifier. Raso@bcbsri. Jun 1, 2024. D. To attend the session online, please join using Microsoft Teams. If you are a Preferred Provider Organization (PPO) member, the doctor will recognize the PPO Suitcase logo, which will ensure you will get the PPO level of benefits. BCBSRI is your contact for claims payment, problem resolution, and adjustments. This list is current as of July 1, 2024, and is subject to change. Effective January 1, 2025, BCBSRI will move from facility contracting and billing and will start credentialing licensed chemical dependency professionals (LCDPs) individually. Connect with member customer service or find the right support resources, including your local Blue Cross and Blue Shield (BCBS) company, general FAQs and media relations Rhode Island Help Center: Important contact information for Blue Cross & Blue Shield of Rhode Island. With a single log-in or phone call, you can access health and wellness apps, plan information, care management, and customer service—and get personalized health support from Care Guides, nurses, and coaches. Six-digit extension for contact phone number In the BCBSRI MHK Provider Portal, providers will now have the ability to add a six-digit extension to their contact phone number. Providence, Rhode Island 02903. Following the call, we will post a summary of topics covered to our Provider Conference Info page on our secure provider portal. To make an appointment, you may either call the practice directly or contact BCBSRI Behavioral Health Case Management for assistance By providing my phone number/email address, I give Blue Cross & Blue Shield of Rhode Island permission to contact me. Explore Medicare providers and brokers near you. Any errors on these reports are either Provider or member related. Annually. Updates from Provider Relations Review Claims Status Check Member Benefits & “Provider” and the “Credentialing Contact” Becoming a Participating Doula with BCBSRI 5 Step 4: Fill out your mailing address 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. There is not enough time for mail, so please Medicare Advantage See all your options, compare plans, and enroll. org prior We contact provider offices directly, via fax, to ensure this information is accurate and up-to-date. Effective July 2024, BCBSRI began performing additional prepayment claim reviews using Optum’s Comprehensive Payment Integrity (CPI) tool, which ensures that claims are processed and paid accurately. ICP Update. I need to send mail about my membership: Blue Cross and Blue Shield of Illinois PO Box 650713 I'm a provider in a BCBSIL network and have a question: PCP $0 cost sharing. Call 800-676-BLUE (2583) Log into Availity. BCBSRI offers our Medicare Advantage members a meal delivery program However, our system was not updated correctly, and providers/groups were receiving payment for these services. Semi-Annually. Understanding and meeting the linguistic needs of our members is a shared concern of BCBSRI and our contracted providers. for a confere P B F . Monthly . Click on Forms. You can contact us online anytime day or night with Secure Messaging. • If the Provider is unable to submit through the Provider Portal, or the Portal is down, they can submit via Phone at 1-800-274-2958 REQUIRED INFORMATION FOR AUTHORIZATIONS SUBMITTED THROUGH BCBSRI PROVIDER PORTAL The following fields are required: Phone Number Requesting Provider’s Phone number If your agency has any authorization inquiries, please contact BCBSRI’s Utilization Management team at 401-272-5670, option 4 or Prospect Utilization Management at 1-844-762-9231. The updated form can be found here. MVP. Medicare Advantage and Community Plan 800-600-9007. com PCP $0 cost sharing. If you have any additional questions after reviewing the information, please contact our Provider & Physician Call Center at (401) 274-4848. Providers must give BCBSRI a 60-day notification of any provider or practice changes. Select how many miles away the provider may be from the above zip code: Within zip code 5 10 15 25 30 Languages Specialty : SEARCH TIP If you are unsure of the spelling of the Provider's name, enter only a portion of the name. com and chat with a live agent or send a secure message. com account or need to make changes to a provider’s demographic information, please contact Provider Relations. Click here for a Provider Identification Number (PIN). Blue Cross Blue Shield of Massachusetts P. All other marks and names are property of their respective Carelon Provider Portal. Privacy & Legal BCBSRI’s PQIP booklet contains acceptable codes for each of the PQIP measures. C. As always, we ask that you verify BCBSRI member benefits and eligibility by logging on to the secure provider portal of bcbsri. This type of coordinated care makes it easier for you to find your way through the healthcare system so you can focus on getting or staying healthy. Please submit all practice demographic changes as soon as possible to avoid any delays in claims payment. Contact us to see if you qualify: 1-877-255-3259 (TTY: Reminder: Please attend a provider portal training session. Quincy, MA 02171-9134 Your primary care provider (PCP) can coordinate your care with specialists, labs, hospitals, and any other providers you might need. Larger offices can continue to submit through their clearing Access provider publications including: Participating Provider Administrative Manual; BCBSRI Practice Guidelines; Orientation visits. Before you visit a doctor on this list, please contact the office to make sure network membership is unchanged. COM PAYMENT POLICY | 1 POLICY LAST REVIEWED : 05|15|2024 OVERVIEW . See slide 7 for MVP criteria. May 16, 2024. You can also emulate the web account. After logging into your account, you will see Web Claim Submission on the left-hand side. High >20. com. Following the alphabetical list are listings by location and specialty, and by the type of provider. BCBSRI has dedicated resources to providing additional educational training sessions and we encourage all network providers to take advantage of this opportunity. Click on Case Management 2 High-Value Provider network consists of Care New England, Oak Street Health, and Prospect CharterCARE primary care provider (PCP) groups. You can also find our telephone numbers and hours of operation on the Contact Us page. Care Plan Update Frequency. og to set up a provider portal orientation. Frequently Asked Questions from BCBSRI Provider Conference Calls . BCBSRI. Policy@bcbsri. Our goal is to make sure that our members continue to have access to effective medications at the lowest possible cost. Moderate. Please note from time to time it may be necessary for our Medical Director or their designee to speak to the provider directly. The 2023 PQIP booklet and future updates can be found on the BCBSRI Provider Portal under Quality > $0 meal delivery after an inpatient hospital stay. You don't have to be an expert to get great Medicare coverage. Interqual® Criteria; Developers; 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. When you are due for recredentialing, BCBSRI will verify with CAQH that you have a current application on file. Call your Blue ® Plan for pre-certification or prior authorization, if Using the links on the left, you can view the details of member, employer, and provider web accounts. Thank you! Here's your guide! Get Your FREE Guide Expansive network, including 12,000 providers & 100% of Self-guided Study: Complete the 2025 Provider Attestation form Point of Contact. See your Evidence of Coverage. 500 Exchange Street. Don’t see your provider on the BCBSRI portal? Please note that only your office administrator can add providers to your BCBSRI. How insurance works; If you have questions about whether or not your claims meet all conditions of a clean claim, contact: Physician and Provider Service (401) 274-4848 1-800-230-9050 Monday Beginning in October, providers who participate in our PCP Quality Incentive Program (PQIP) began seeing additional health equity data in their “gaps in care” reporting. We went back 18 months, to 9/1/2022 and have requested to have those overpayments retracted and requested to deny as f12 not separately reimbursed. BCBSRI will require that all LCDPs are individually credentialing by February 1, 2025. Non-participating providers: Call the number on the back of the member’s ID card or call 800-676-BLUE (2583) to reach Provider Services. Please have the care provider’s full name, Tax ID, and National Provider Identifier (NPI) available. com . If you have multiple chronic conditions and are enrolled in a Medicare Advantage plan with Blue Cross & Blue Shield of Rhode Island, you may be eligible for HouseCall by Blue. Please send updated Contact Information for your practice, including email and telephone numbers. If you do have any questions regarding your physician’s tiering, please reach out to the CARE Team. org prior to the meeting. Membership and Claims Mailing Addresses. If you are not sure who your Provider Relations representative is you can reach out to Provider. The requesting provider of the authorization can now view correspondence which have been sent via fax or mail. Simply click the hyperlink of the correspondence you wish to view and the correspondence will appear in a new window. That's our job. Some services require referrals. Please take a moment to review your practice information in our Find a Doctor tool, focusing on the following areas: Panel status refers to whether or not you are accepting new patients, which applies to specialists as well as PCPs. Mail: Blue Cross & Blue Shield of Rhode Island. Tiering of ASC/OP hospital cost sharing The notice shall be sent by certified mail, return receipt requested, postage prepaid. Medicare can be confusing. For more information about Medicare, including a complete list of plans available in your area, In late 2023, it was announced that after the PHE ended for Medicare effective 12/31/2023, Telemedicine services for Medicare members would begin requiring their in-office copay for services rendered on or after 1/1/2024. If you have any questions about this change, please contact ProviderRelations You can contact Provider Services using the method that works best for you. org. You can also use the Find a Doctor tool at bcbsri. Routine membership, eligibility, benefit information, and claims status for all BCBSRI Sign in to your Blue Cross Blue Shield of Rhode Island account. According to State of RI regulations, BCBSRI will make two attempts to schedule a peer-to-peer discussion for appeals denied for medical necessity. from BCBSRI’s providers and health system partners, as well as the healthcare industry. Contact if interested/for more information: LouAnne Giangreco, M. Referrals will be required when being treated Each Blue Cross and Blue Shield company is responsible for the information it provides. Jan 18, 2023. ” Upon completion of the form, your PIN will be emailed to you. 3. More ways to connect: Visit your nearest retail location or contact us. Any provider removed from the Provider Directory for failure to attest in Q3 of 2024 will receive a notification from BCBSRI. If you have any questions about changes to the behavioral health fee schedules, please contact Provider Relations at 1-844-707-5627 or email ProviderRelations@bcbsri. When you emulate the account, you will see Find an eye doctor. If you are having trouble receiving your PIN, please contact Provider Relations at ProviderRelations@bcbsri. What is Beginning January 1, 2025, BCBSRI requires that participating providers who treat or diagnose patien P F . If you do not know who your administrator is, contact your Provider Relations representative. BCBSRI invites providers to join us on Tuesday, November 14, 2023 from 10-11 a. com This allows you to access self-service tools or connect to a chat advocate for support. Telemedicine ; 2024 Updates; Upcoming live D-SNP training dates; Provider data; We encourage you to submit any questions you would like addressed BCBSRI invites providers to join us on Tuesday, April 9 from 10-11 a. Providers are tiered and can find their tier status by using the BCBSRI Provider Finder. Beginning January 1, 2025, BCBSRI requires that participating providers, who treat or diagnose patients for substance use disorders or refer patients for treatment of substance use disorders and are subject to the Confidentiality of Substance Use If you have questions or concerns regarding this audit, please contact Senior Quality Management Analyst Laura Raso at (401) 459-5989 or Laura. Nutrition plays a critical role in maintaining optimal health—and we want to help! BCBSRI offers our Medicare Advantage members a meal delivery program through ILS Meals by Independent Living Systems. This policy is applicable to facilities reimbursed based on a contracted diagnosis-related group (DRG) or case rate methodology. This includes services such as durable In order to make the appeals process more efficient, please ensure you provide a valid name and phone number on your appeal requests for the person who will schedule peer-to-peer discussions. Relations@bcbsri. ©Copyright 2023 Blue Cross 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 To find nearby doctors and hospitals, access the Find a Doctor or Hospital tool or call BlueCard Access at 1-800-810-BLUE. for a conference call with the Provider Relations team, who will provide updates and reminders on the following topics:. You will be notified by BCBSRI if you have missing or outdated documents. Click on Tools and Resources . Provider Credentialing Committee. primary care transition, you’re welcome to contact BCBSRI at 1-800-637-3718, ext. As a BCBSRI-contracted provider, it is your obligation to coordinate member care with contracted, in-network providers, for all BCBSRI plans and products. Please Contact Physician and Provider Service Center: (401) 274-4848 1-800-230-9050 Monday through Friday, 8:00 a. If you need assistance adding your provider to your BCBSRI. Attention: Medical Policy, CPT Review. Last name. com by following these easy steps: 1. 4. You must provide 60 days notice to Call the dedicated pharmacy program phone number listed on your member ID card. including a complete list of plans available in your area, To obtain a Prior Authorization after-hours, providers may contact OptumRx at the following numbers: Medicare: 866-235-1793, ext. Contact plan for details. If you have any questions about changes to our standard fee schedule, please contact provider relations at 1-844-707-5627 or email ProviderRelations@bcbsri. Call 1-866-304-2138 to order products over the phone. With your member ID card, you have access to thousands of providers across the country. com to confirm member coverage prior to rendering services. BCBSRI invites providers to join us on Tuesday, February 13, If you have any questions regarding this call, please contact ProviderRelations@bcbsri. The Centers for Medicare & Medicaid Services (CMS) requires providers to note whether the location included is the same as • Encourage members to contact BCBSRI customer service to learn more about coverage for spirometers. Low + Opt Outs <10. Purpose and objectives: To ensure providers wishing to participate in the BCBSRI provider network have appropriate qualifications and meet credentialing requirements as set forth in the BCBSRI Credentialing Policies and Procedures (P&Ps). • Phone number • TIN • Office hours • On the BCBSRI MHK Provider Portal, provider correspondence is now available under the “View Authorizations” section. REPORTING AND PAYMENT SCHEDULE 2020 Incentive Payment Schedule Program Year contractual obligation—that providers give BCBSRI a 60-day notification of any provider or practice changes. We’re asking offices to update the link(s) if they are saved in their favorites, as the old link will no longer work. Log on to the provider portal of BCBSRI. 2 Doctors Online is a telemedicine service provided by American Well®, an independent company that administers Doctors Online on behalf of BCBSRI. Toll-free: 800-288-2227. 1-800-451-8124 (Ancillary Providers) Dental providers Dental Provider Services 1-800-882-1178 BlueCard ® member benefits and eligibility (members from another Blue plan) 1-800-676-BLUE (2583) Technology InfoDial User guide 1-800-443-6657 Normal hours: Phone. This new, more efficient process eliminates the need to mail or fax a Learn more about filing a complaint to Medicare about the quality of care or other services you receive from a Medicare provider. We encourage you to submit any questions you would like addressed during the call to ProviderRelationsSeminars@bcbsri. Click this link. Failing to provide direct contact information may delay the provider's enrollment request. Items will be shipped to you at no cost. These sessions are typically 30-60 minutes long and will consist of a demo of the authorization process and trained staff Medicare Advantage See all your options, compare plans, and enroll. BCBSRI does not Credential Groups. If you have any additional questions about these changes or webinar registration, please contact Provider Relations at 1-844-707-5627 or ProviderRelations@bcbsri. to 8 p. General Member Service Correspondence. As a local institution that has served the community for National Information Center. We also have South Carolina BLUE retail centers in Columbia, Greenville and Mount Pleasant where you can speak to us in person. If all of your required credentialing documents are current, we will access the information and process the application. If you have Blue Cross Vision, use this option for routine eye exams, glasses, and contacts. This report advises you if the file was accepted or rejected for Compliance Reasons. In order to make the appeals process more efficient, please ensure you provide a valid name and phone number on your appeal requests for the person who will schedule peer-to-peer discussions. When you arrive at a participating doctor's office or hospital, simply present your plan ID card. Any trip over 20 miles will count as additional trips and will be subtracted from your 24 trip total. • We need your help! • We don’t know what you don’t tell us –if you need help setting up a bcbsri. Contact ProviderRelations@bcbsri. Previously limited to four digits, this extension option allows for more accurate contact information, making communication with our UM team easier for those who have extensions more than four digits BCBSRI to Introduce Provider Web PIN Self Service As previously communicated, we have introduced a web personal identification number (PIN) self-service capability. Out-of-state: 1-800-676-2583 Physician and Provider Service Center (401) 274-4848 or 1-800-230-9050 Complex claims inquiries, policies and procedures, business practice change requests, and Web access Please contact your account executive or call our main number at (401) 459-1000 or 1-800-637-3718 outside Rhode Island. Below is a quick overview about how this plan effects providers: All providers participating in the Blue network are included in Lifespan’s coverage. The 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 need guidance on verifying the information for providers in your office, please contact ProviderDirectory@bcbsri. Click on Tools and Resources. You must provide 60 days notice to If you are a provider in Michigan, contact Blue Cross Blue Shield through our association of doctors and hospitals, including Blue Care Network providers. We are currently beginning the pilot stage of our testing, and are hoping to go live for all providers in January of 2024. If you have any questions regarding D-SNP product and are a PCP, please contact pcprequests@bcbsri. You can contact us in a couple of ways: Check the back of your membership card for your specific customer service If you have questions, please contact our Physician and Provider Service Center: (401) 274-4848 or 1-800-230-9050 Monday through Friday 8:00 a. Electronic attestations are now live on our secure provider portal and have replaced fax attestations. to noon, CT on weekends and holidays) Electronic Commerce Services. Horizon Blue Cross Blue Shield Providers numbers & addresses. Primary care providers (PCPs) are usually a patient’s most influential and most important point of contact for their healthcare needs, from delivering preventive care and recommending screenings to treating illness and addressing chronic health challenges. If you have questions about the 2020 PCP Quality Incentive Program, please contact your quality concierge team representative, or send an email to QualityHEDIS@bcbsri. 137 drugs moving from Preferred Generic to Generic Become a participating provider Use this form to add a new practice or a new provider within a practice. Effective January 1, 2020, BCBSRI will become the insurer for all Lifespan employees. We recommend that this notice be sent Attn: Provider Relations. , CT; and 9 a. Contact phone number. 500 EXCHANGE STREET, PROVIDENCE, RI 02903-2699 (401) 274-4848 WWW. Why choose BCBSRI? Network coverage; Pharmacy & prescriptions; What's included in all plans; Your Blue Store; Provider Credentialing and Recredentialing Process Upload date. 2. We recommend that this notice be attention to Provider Relations. And mark your calendar for our next conference call on Tuesday, March 12, 2024. Fill out the required information & click “Go. for a conference call with the Provider Relations team, who will provide important updates and reminders. Wide network with more than 12,000 providers; $0 copays for primary care provider (PCP) visits; $0 preventive services like well visits, screenings, and vaccinations; Point of service (POS) benefit for out-of-state flexibility; Some services require referrals. • Providers who did not attest to their information last quarter, have been excluded from the BCBSRI provider directory- Find a Doctor Tool. BCBSRI’s Quality Concierge Team is available to help troubleshoot any concerns you may have with opening or reading GIC reports. To make the appeals process more efficient, please ensure you provide a valid name and phone number P B . com, please contact ProviderRelations@BCBSRI. Each batch transmission you send (834/837/820/270/276) BCBSRI will create a 999 report. Quarterly . View PDF. Visit your nearest retail location or contact us. Members are able to elect into this program if they are actively enrolled in a Medicare Part D plan. Sign into your BCBSRI. Every BCBSRI plan includes 100% in-network coverage for your annual physical, flu shot, and recommended tests and screenings. you or your representative may contact the Medicare Concierge team directly by calling the phone number in the Contact Information section at the end of this page. • Having updated provider data is extremely important for both the member and provider! The quarterly data attestation includes confirming practice location, phone number and accepting new patients' status, etc. Care Manager. If your doctor is not yet in the BCBSRI network, they can use this form to request participation: Become a participating provider If you have questions, please contact the Utilization Management Department: (401) 272-5670 1-800-635-2477 (outside of Rhode Island only) (401) 272-8885 (fax) deem the action a violation of this policy and severe action will be taken up to and including termination from the BCBSRI provider network. The BCBSRI wellness program makes it easy—and fun—to take steps toward better health. . We contact provider offices directly, via fax, to ensure this information is accurate and up-to-date. BCBSRI offers our Medicare Advantage members Refer to the phone number on the back of your card. Call us if you’d like an orientation at your office about provider publications or: Online preauthorization requests – This is a convenient way to submit preservice or aftercare authorization requests. com or call our Customer Service Department at 1-800-267-0439, October 1 - Type of Provider There are approximately 1,359 Primary Care Physicians (PCP), 5,489 Specialists, 15 Hospitals, 22 Urgent Care Facilities, 2,787 Behavioral Health Providers and Phone Number Language Spoken. You’ll now see a link in the sidebar called “Update Practice Info. Box 9134 N. BCBSRI is committed to continuously improving payment integrity to prevent overpayments due to waste or abuse. View the OTC catalog. to 6 p. Dec 1, 2024. If you BCBSRI has collaborated with providers throughout Rhode Island to ensure that our members have access to urgent appointments for behavioral health needs, such as outpatient therapy and medication management. See your Evidence of Contact phone number. The web administrator for your practice should follow their ©2024 Blue Cross and Blue Shield of North Carolina. Use the Find a Doctor tool if your vision exam is covered under your medical plan. Medical; Dental; Behavioral Health; Resources; About. Medicare copay for telemedicine correction reminder ; New vs existing patient audit ; Last live D-SNP training dates Self-guided Study: Complete the 2025 Provider Attestation form Point of Contact. UnitedHealthcare Oxford Health Plan 800-666-1353 To refer a patient to the BCBSRI BH Case Management Program, please call 1-800-274-2958 or email triage_group@bcbsri. You can email us at QualityHEDIS@bcbsri. Therefore, we would like to inform you that there is a new language resource available to you on the BCBSRI provider portal. • Providers must attest by December 31st (end of Q4) to ensure they You must receive all routine care from plan providers unless you select the BlueCHiP for Medicare Value (HMO-POS), BlueCHiP for Medicare Extra (HMO-POS), BlueCHiP for Medicare Preferred (HMO-POS), or the HealthMate for Medicare (PPO) plan. Tiering of ASC/OP hospital cost sharing BCBS Provider Phone Number; Alabama: 800-517-6425 (Benefits/Eligibility) 800-327-3994 (PEEHIP) 800-760-6851 (Customer Service) 800-492-8872 (Federal Employee Program) 800-668-3813 (Healthspring) Alaska: 800-722-4714 (Claims, Benefits/eligibility) Premera Blue Card Provider Phone Number: 888-261-9562 (Claims) If your agency has any authorization inquiries, please contact BCBSRI’s Utilization Management team at 401-272-5670, option 4 or Prospect Utilization Management at 1-844-762-9231. This Medicare Prescription Payment Plan fact sheet has helpful information about the program and will be sent to all BCBSRI Medicare Part D members. BCBSRI has seen an increase in claims processed by out-of-network providers or laboratories which were referred by a participating BCBSRI provider. This directory is a provider listing only and does not imply coverage of any particular On January 1, BlueCare Connect will replace myBCBSRI. Dental Direct Basic; Dental Direct Standard; Dental Direct Plus; Dental Direct Elite For any other provider inquiries not associated with this training, please email ClientServices@evicore. January 12th call . ; Medicare Supplement Help cover costs with a Plan 65 option. Why choose BCBSRI? Network coverage; Pharmacy & prescriptions; What's included in all plans; Your Blue Store; Wellness programs; Insurance basics. Navigation. Carelon Contact Center – 866-455-8415 (Monday through Friday, 6 a. com Provider Portal by clicking here. 2025 Medicare changes. Please note this information would not be shared outside of BCBSRI. A customer service representative will respond to your request within one If you are not an approved Medicaid provider and are unable to submit your claim from BCBSRI to Medicaid, you will not be allowed to bill the member for the copay/coinsurance. The purpose of this Blue Cross & Blue Shield of Rhode (BCBSRI) Provider Credentialing and Medicare Advantage See all your options, compare plans, and enroll. This new data indicates how members of your panel of different races and ethnicities are performing relative to various HEDIS® measures. Not near one? The following table includes some common reasons providers contact us and options for each. Do you feel your office needs a better experience with our secured Provider Portal? Let our Provider Relations team help guide you through the portal. Beginning February 5, 2024, BCBSRI will no longer require a Notice of Admission for the following services: Intensive Outpatient (mental health and/or substance use disorder) Child and Family Intensive Treatment (CFIT) Medicare Advantage See all your options, compare plans, and enroll. Back to Provider Update. If you are interested in BlueCHiP Direct Advance, call our sales team at (401) 459-1000 . BCBSRI Outreach. org or reach us by phone at (401) 459-1005 if you have any questions about our PCP Quality Incentive Program (PQIP), Gap in Care Reports, or any other quality We will soon begin publishing provider race and ethnicity in our Find a Doctor provider directory on bcbsri. You may also use our automated referral form at BCBSRI. Click on Forms . BCBSRI participating providers will be able to obtain their PIN electronically when registering on bcbsri. BCBSRI invites providers to join us on Tuesday, December 12, If you have any questions regarding this call, please contact ProviderRelations@bcbsri. Medicare Advantage See all your options, compare plans, and enroll. TABLE OF CONTENTS ALPHABETICAL PHYSICIAN/PROVIDER For any other provider inquiries not associated with this training, please email ClientServices@evicore. 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 also offer a plan, BlueCHiP Direct Advance, that includes a smaller network of providers than the BlueCHiP Direct plan. We do this to ensure personalized service for every member. First name. When entering a Servicing or Facility Provider, you may be presented with a choice to select either Par or Contracted status in the Servicing Provider field - Par should always be selected. You can also use chat or secure To make the appeals process more efficient, please ensure you provide a valid name and phone number on your appeal requests for the person who will schedule peer-to-peer discussions. As part of our ongoing efforts to make high-quality and affordable healthcare available to our members, Blue Cross & Blue Shield of Rhode Island (BCBSRI) regularly reviews the list of prescription drugs we cover under our medical benefit. If you do not have a BCBSRI account, please create one by clicking here. Please call the Customer Service telephone number on the back of your Member ID card. Primary care is the backbone of the healthcare system. Habla usted español? Online. m. BCBSRI invites providers to join us on Tuesday, December 10, 2024&nbsp;from 10-11 a. Important tips and guidelines BCBSRI invites providers to join us on Tuesday, March 12 from 10-11 a. Quarterly. This feature will show any open authorizations and up to six months of approved authorizations. BCBSRI provider agreement. BCBSRI is committed to improving health equity for our members and the healthcare system. All PCP visits (including sick visits) will now have a $0 copay for dates of services on or after January 1, 2025. According to RI State regulations, BCBSRI will make two attempts to schedule a peer-to-peer for appeals denied for medical necessity. Provider Contacts ‌ Physician Services ‌‌ 1-800-624 BCBSRI has updated our Hospital Readmission Payment policy for readmissions to an acute general short-term hospital. 1-800-411-BLUE (2583) Weekdays from 8 a. S. to your local Blue plan — BCBSRI. Health plan support All Savers® Health Plan 800-291-2634. Contact us if you have questions about electronic transactions that cannot be answered by your clearinghouse or software vendor. We have updated the credentialing form for new providers looking to become participating BCBSRI providers. Eastern Time (excluding holidays) Call the National Information Center for information about your benefits and services, FEP incentive programs, our To refer a patient to the BCBSRI BH Case Management program, please call 1-800-274-2958 or email triage_group@bcbsri. If you have any questions regarding this change, please contact ProviderRelations@bcbsri. : 16675 BCBSRI network of providers, but their out-of-pocket copay, coinsurance, and deductible will vary based on the rendering provider’s tier. ®, SM Marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. All plans offer this payment option and participation is voluntary. We encourage you to submit any questions you would like addressed during the call related to the topics above, or to other topics, to ProviderRelationsSeminars@bcbsri. 10-20. You should see these adjustments in the next couple of weeks. If you have any questions regarding submitting a secure message, please contact our Provider and Physician Call Center at (401) 274-4848 or 1-800-230-9050 for out-of-state providers. Interqual® Brown University Health does have additional providers that are considered Tier 1 that may not be on this list. You can also email us at triage_group@bcbsri. Q: PPE supply code 99072 – BCBSRI does not cover this code at the committee needs to reach out to the provider but without an updated phone number, terminating the provider may be the only option. Small offices will be able to submit claims directly through bcbsri. Back to Provider Update What information are you looking for? For additional information or to find a Headway provider, please visit: Headway | Find Therapists Covered by Your Insurance or contact BCBSRI Behavioral Health Care Management by phone at 1-800-274-2958 or triage_group@bcbsri. Coming soon BCBSRI will be introducing online web claim submission through bcbsri. Click on Case Management Medicare Advantage See all your options, compare plans, and enroll. BCBSRI. Members can opt in to this program if they are actively enrolled in a Medicare Part D plan. com provider account, adding Our general phone number is: 803-788-0222. Tiering and formulary updates for Medicare members: 470 drugs moving off formulary ; 936 drugs moving to Higher Tiers; Tiering changes. O. ahowt xsqoigq rijemxjg ced gxndh cvr rpp jqdu gwythv amaog