Bcbsri com providers rhode island. Blue Cross & Blue Shield of Rhode Island is an .

Bcbsri com providers rhode island Log on to the provider portal of BCBSRI. In compliance with Rhode Island law, if you wish to end your participation with BCBSRI as a result of the updated fee schedules, you may notify BCBSRI of your intent to terminate your Participating Physician/Provider Agreement within sixty (60) days of receipt of this notification. BCBSRI. BCBSRI continues to invest in our Systems of Care by establishing rate differentials that support this goal. Phone: (401) 459-5603 Email: monica. RIS (Rhode Island State) and R2I (Rhode 2 Island). com Dec 9, 2024 · Effective January 1, 2025, State of Rhode Island employees who have a plan with a prefix of ‘R2I’ will no longer require a PCP referral. These providers have dedicated time slots available exclusively for BCBSRI members. BlueLine (401) 272-1590 or 1-800-327-6712 Routine membership, eligibility, benefit information, and claims status for all Blue Cross & Blue Shield of Rhode Island members In 2022, Blue Cross & Blue Shield of Rhode Island (BCBSRI) expanded our commitment to providing access to high-quality, affordable, and equitable care. Blue Cross & Blue Shield of Rhode Island is an After the out-of-pocket is met, in-network covered services are paid at 100% by Blue Cross & Blue Shield of Rhode Island. This information applies to members of all Blue Cross & Blue Shield of Rhode Island plans except BlueCHiP for Medicare. Secure messaging is located on the left-hand tool bar once you log in to bcbsri. You can contact us in a couple of ways: Find a doctor or other health care provider who accepts your plan. Let us know what you think. com; however, you can call our Physician & Provider Service Center at (401) 274-4848 or 1-800-230-9050 (for out-of-state providers) who will be able to confirm the authorization we have on file for your patient. Please ask your administrator or BCBSRI Provider Relations for assistance adding your provider to BCSRI. You can file claims electronically or on paper for Blue Cross & Blue Shield of Rhode Island plan members and out-of-state Blue Cross & Blue Shield plan members. Oct 1, 2021 · All trademarks unless otherwise noted are the property of Blue Cross & Blue Shield of Rhode Island or the Blue Cross and Blue Shield Association. Complaints and appeals may be filed with BCBSRI by contacting the Physician and Provider Service Center at (401) 274-4848 or 1-800-230-9050 or by submitting a request in writing to: Grievance and Appeals Unit Blue Cross & Blue Shield of Rhode Island 500 Exchange Street Providence, RI 02903-2699 Please contact Monica Boulay, Doula Provider Relations Representative. Click on Case Management Jul 1, 2023 · As a reminder, there is a functionality on the BCBSRI Provider Portal that allows providers to send inquiries via secure messaging. Feb 1, 2020 · This one-time upload of the authorizations will not be visible on the Provider portal of bcbsri. Blue Cross & Blue Shield of Rhode Island ATTN: Claims Department 500 Exchange Street Providence, Rhode Island 02903-2699. m. Blue Cross and Blue Shield of Rhode Island is an independent licensee of the Blue Cross and Blue Shield Association. Referral An order from your primary care provider (PCP) for you to receive care from another doctor, specialist, or medical facility. Nov 1, 2024 · 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. If you have questions, please contact the Utilization Management Department: (401) 272-5670 1-800-635-2477 (outside of Rhode Island only) Your primary care provider (PCP) can coordinate your care with specialists, labs, hospitals, and any other providers you might need. Oct 1, 2024 · BCBSRI network participation. com. These employees will be on a plan referred to as the “Anchor Plan. Medicare Advantage plans Provider Credentialing and Recredentialing Process Blue Cross & Blue Shield of Rhode Island is an Contact Us. Provider Directories. Hours: Monday – Friday, 9:00 a. Click on Tools and Resources. Dec 10, 2024 · All trademarks unless otherwise noted are the property of Blue Cross & Blue Shield of Rhode Island or the Blue Cross and Blue Shield Association. Previous versions. D-SNP FAQ; BCBSRI 2025 DSNP Training; Training Attestation Oct 1, 2021 · Our BlueCHiP for Medicare (HMO-POS) plans, the most popular Medicare Advantage plans in Rhode Island, all include $0 primary care provider visits, $0 dental, vision, and hearing, a $0 pharmacy deductible, $0 generic drugs, a Flexible Benefit Card, and a large network with a point of service (POS) option. During the time of the COVID-19 pandemic, effective March 17, 2020, the lower copayment will automatically be applied for dates of service of March 17, 2020 and going forward until further notice. General Documents. Always carry your current ID card for easy reference and access to service. When you're a Blue Cross and Blue Shield of Rhode Island plan member, you take your health care benefits with you — across the country and around the world — through the BlueCard program. Jun 1, 2022 · Please note that only your office administrator can add providers to your BCBSRI. These claims should be filed to the primary carrier. There are three ways you can search for providers and other healthcare services. The purpose of this Blue Cross & Blue Shield of Rhode (BCBSRI) Provider Credentialing and Mar 11, 2024 · Rhode Island Energy's member ID cards have been updated with Anthem Blue Cross. Feb 1, 2020 · Rhode Island NEHP member has a RI PCP who wants to go see a cardiologist in Massachusetts. This is the foundation of everything we do to help Rhode Islanders live their healthiest lives. In addition, BCBSRI continues to invest and expand in programs that support the triple aim of better health for our state, a simpler patient experience, and lower costs. The purpose of this Blue Cross & Blue Shield of Rhode (BCBSRI) Provider Credentialing and Explore health plan coverage, find providers, and manage your account with the Blue Cross and Blue Shield of Rhode Island. 500 exchange street, providence, ri 02903-2699 medical coverage policy | 3 (401) 274-4848 www. COM PAYMENT POLICY | 1 POLICY LAST REVIEWED : 05|15|2024 OVERVIEW . • 1Type the name of a doctor, medical specialty, or procedure into the search bar. Apr 1, 2020 · The State of Rhode Island (SORI) Anchor plans have a copayment differential for specialist visits. Brown University Health does have additional providers that are considered Tier 1 that may not be on this list. Services requiring claims submission A claim must be submitted for all services not included in a capitation compensation arrangement. boulay@bcbsri. Medicare Advantage See all your options, compare plans, and enroll. In the following instances, claims should not be submitted to BCBSRI: When there is another medical insurance carrier that is primary over BCBSRI. Enrollment in Blue Cross & Blue Shield of Rhode Island depends on contract renewal. If you do have any questions regarding your physician’s tiering, please reach out to the CARE Team. • Use the ‘Common Search’ feature to select from one of six options: Radiology & Imaging Centers, Labs & Tests, DME & Medical Supplies, Physical Find a doctor or other health care provider who accepts your plan. You can contact the number on the back of their card for their benefits and eligibility. ; Medicare Supplement Help cover costs with a Plan 65 option. effective date: 01|01|2018 policy last updated: Check status of all claims submitted with your National Provider Identifier (NPI). Dec 1, 2024 · Medicare Advantage See all your options, compare plans, and enroll. X. Blue Cross & Blue Shield of Rhode Island is an HMO and PPO plan with a Medicare contract. Nov 1, 2023 · Rhode Island Energy's member ID cards have been updated with Anthem Blue Cross. 3. Blue Cross & Blue Shield of Rhode Island is an independent licensee of the Blue Cross and Blue Shield Association. Rhode Island-based network; Lower premiums and out-of-pocket expenses when you work with your primary care provider (PCP) to coordinate your care; All Rhode Island hospitals; 1,400+ PCPs; 4,000+ specialists All trademarks unless otherwise noted are the property of Blue Cross & Blue Shield of Rhode Island or the Blue Cross and Blue Shield Association. mywealthcareonline. See how close you are to meeting your deductible or out-of-pocket limit. You can even compare costs once you log in. Dec 1, 2024 · For additional information or to find a Headway provider, please visit: Headway | Find Therapists Covered by Your Insurance or contact BCBSRI Behavioral Health Care Management by phone at 1-800-274-2958 or triage_group@bcbsri. Looking for a dentist? ¿Desea ver a un médico que hable español? Find out which doctors and hospitals are part of the extensive Blue Cross network. If you are unsure of the spelling of the Provider's name, enter only a portion of the name. Pay your monthly premium, if you have an individual plan. We do this to ensure personalized service for every member. How do we decide which health care services to cover? We take a number of factors into account, including: The terms of your specific benefit plan Oct 11, 2019 · Why choose BCBSRI? Shop plans. com account. . You may also use our automated referral form at BCBSRI. The PCP will need to follow the cross border notification workflow and enter a cross border notification via bcbsri. Click on Forms. A specific customer service center supports each member. 4. Check claims status and patient eligibility, view remittances, and review the Provider Administrative Manual. com; Rhode Island NEHP member has a Mass PCP who wants to see a cardiologist in Massachusetts. Check patient eligibility to verify effective dates of coverage, copays, deductibles, and other information. 2. Dec 1, 2019 · Effective January 1, 2020, BCBSRI will become the insurer for all State of Rhode Island employees. National dental network with more than 55,000 providers—including 9 out of 10 in Rhode Island $1,500 annual benefit max on all covered dental services 1 Plus $280/year to use for dental and/or hearing with the Flexible Benefit Card Services obtained outside the local participating provider network; Skilled nursing facility admissions; To obtain preauthorization, log in to your Provider portal account and use the online tool there. 500 EXCHANGE STREET, PROVIDENCE, RI 02903-2699 (401) 274-4848 WWW. Dental provider portal Please continue to use your BCBSRI payer ID when submitting electronic claims. 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. ” Below is a quick overview of the Anchor Plan: Employees enrolled in the Anchor Plan will require a PCP referral to see most specialists. 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 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. ; Extra Help Plans Medicare + Medicaid and the new Access plans. bcbsri. org. Vision coverage | Blue Cross Blue Shield of Rhode Island Our website uses cookies to enhance functionality and improve your browsing experience. Summary of Most Recent Formulary Changes; Pharmacy Management Procedures; HSA Preventive Drug List; ACA Preventive Drug List; ACA NR Preventive Drug List; ACA Prevention CoPay Waiver Program 9 out of 10 Rhode Island dentists in the Blue Cross Dental network; National coverage coast-to-coast; Coverage for out-of-network care; No waiting periods for exams, cleanings, and fillings (waiting periods may apply for other services) Pediatric coverage that meets Affordable Care Act (ACA) guidelines; Choose a 2025 dental plan Blue Cross & Blue Shield of Rhode Island (BCBSRI) is pleased to offer the 2020 PCP Quality Incentive Program, which rewards PCPs for improving quality and closing gaps in care. If your doctor is not yet in the BCBSRI network, they can use this form to request participation: Become a participating provider If the training is still outstanding after the 10-day period, the deficiency will be referred to the BCBSRI Medical Director for additional follow-up and assistance. com is powered by Alegeus Technologies on behalf of Blue Cross & Blue Shield of Rhode Island and Alegeus is not affiliated with Blue Cross & Blue Shield of Rhode Island. Fill in your search criteria below. Feb 1, 2024 · 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) Aug 1, 2019 · Currently, Blue Cross & Blue Shield of Rhode Island (BCBSRI) utilizes eviCore for high-end radiology prior authorizations. If you have any questions regarding this training, please contact providerrelations@bcbsri. Within the United States. If a member is presented with this card, this Blues plan is a valid Blue Cross plan. Effective October 1, 2019, in partnership with eviCore, BCBSRI will be expanding eviCore’s authorization management to cardiology services. com by following these easy steps: 1. Search for doctors, hospitals, and labs. Exceptions. Blue Cross Blue Shield of Rhode Island; Neighborhood Health Plan of Rhode Island; Blue Cross Dental; Delta Dental; You can also use these provider directories to find a new doctor who accepts your health insurance. As in past years, BCBSRI will make incentives available to PCPs to support improvements in quality, as outlined by nationally recognized programs and measures. Using secure messaging, you can ask questions about: Eligibility/prior authorization/benefits – For Rhode Island members only Jul 1, 2021 · BCBSRI’s ongoing investments in Rhode Island’s provider community. **This does not include RIPTA employees, just the State of Rhode Island** Oct 1, 2024 · Medicare Advantage See all your options, compare plans, and enroll. Blue Cross & Blue Shield of Rhode Island 500 Exchange Street Providence, RI 02903 Local: (401) 459-1000 Outside Rhode Island: 1-800-637-3718 What information are you looking for? BCBSRI Provider Transparency. Contact us to see if you qualify: 1-877-255-3259 (TTY: 711). Nov 1, 2024 · To refer a patient to the BCBSRI BH Case Management program, please call 1-800-274-2958 or email triage_group@bcbsri. 500 exchange street, providence, ri 02903-2699 medical coverage policy | 1 (401) 274-4848 www. The NPI and Tax ID you enter must match what’s in BCBSRI’s system. We are seeing claims coming in as R21 incorrectly and the claims will be kicked out of the system as the prefix is unknown. If you provider is listed on BCBSRI but not appearing in your Dec 1, 2024 · 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. In an emergency, go directly to the nearest hospital. Blue Cross & Blue Shield of Rhode Island is an independent licensee of the Blue Cross and Blue Shield Association All trademarks unless otherwise noted are the property of Blue Cross & Blue Shield of Rhode Island or the Blue Cross and Blue Shield Association. Log in to get personalized search results specific to your plan. – 6:00 p. If you already are an in-network provider and have a question, contact the Provider Call Center at (401) 274-4848 or 1-800-230-9050 if you are calling outside of Rhode Island. Access provider publications including: Participating Provider Administrative Manual; BCBSRI Practice Guidelines; Orientation visits Feb 1, 2020 · As a reminder, the State of Rhode Island has two prefixes for their account. hkltlsm feqf jriup yfhyr jbwlnvk wodsnk yobuvv ggttxex dcdcf wyqu