Bcbsri provider benefits form online Upon completion of the form, your PIN will be emailed to For certain health issues, you can receive care from your provider over the phone or by video. We’re ready to help. View events calendar. ” You receive it when you are responsible for paying a share of the claim that a doctor submitted to BCBSRI. Services such as dental services rendered in the outpatient setting will not be authorized by this system. They can also assist if you’re simply looking for a participating behavioral health provider. ILS Meals is one of the nation’s largest nutritional providers, delivering high-quality, medically tailored therapeutic meals. provides beneficiaries with access to Medicare and Medicaid benefits managed under one health plan. Methadone maintenance. Pay the lowest available price AND have covered Rx purchases applied to your deductible. Overview; Shop; Provider Update; Forms; Doula application information; Become a participating provider; D-SNP Training; BCBSRI Update. Purchases made online or by phone using the catalog may also be different than what you find in stores. Doctors Online gives you access to quality care anytime, from the comfort and safety of your own home—for $0. Online” from the App Store or Google Play* or visit drs-online. We went back 18 months, to 9/1 As a reminder, there is a functionality on the BCBSRI Provider Portal that allows providers to send inquiries via secure messaging. Medicare Advantage plans; Extra Help plans; Medicare Supplement; FAQ; Provider Guidelines for Requesting Point of Service Payment and Maintaining Patient Credit Card Information Starting January 1, 2021, all BlueCHiP for Medicare plans include an over-the-counter (OTC) benefit program enhancement. Self-guided Study: Complete the 2025 Provider Attestation form providers, and BCBSRI care team. This form must be mailed to our claims department at the following address, which is also listed on the bottom of the claim adjustment form: Blue Cross & Blue Shield of Rhode Island 2025 plan benefits; Documents & forms; Find a doctor, dentist, or pharmacy; Flexible Benefit Card & OTC; FitOn Health benefit; Billing, payments, & claims; deem the action a violation of this policy and severe action will be taken up to and including termination from the BCBSRI provider network. Value Based Benefit (VBB) Incented Copay Drug List. Schedule a call For a complete list of covered benefits and exclusions, view Benefits in your online account, as well as Subscriber Agreements, to view your plan benefits and services. com or on the MyBenefits app. o What happens if a member loses eligibility? Cross & Blue Shield of Rhode Island (BCBSRI) online prior authorization tool. Record the member’s BlueRI for Duals and Anchor cards in your EMR to ensure the member is accessing their fullest coverage for both of their plans. You must be enrolled in a plan that includes Part D prescription drug coverage. Below is a quick overview about how this plan effects providers: All providers participating in the Blue network are included in Lifespan’s coverage. Find out which doctors and hospitals are part of the extensive Blue Cross network. effective date: 11 |01 2024 policy last reviewed: Attend an in-person or online event. $60/quarter over-the-counter (OTC) benefit for everyday health items (Flexible Benefit Card) $100 annual wellness reimbursement; $0 fitness benefit; $0 rides; 40 hours/year of household help 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. 2. Send your PA form to: For any other provider inquiries not associated with this training, please email ClientServices@evicore. Fill out the required information & select "Go. If you need your order sooner, please call or order online. 833-696-2087 (TTY: 711) Provider Update; Forms; Doula application information Oakley®, Coach®, and more. ). (There are specific instructions on each form. After completing the training, you are to complete the D-SNP Provider Attestation Form below. NationsBenefits. Some BCBSRI plans, such as our BlueCHiP plans, require you to have a PCP. New mail order pharmacy. . To find a participating store nearby, please visit MyBenefits. org Provider education, responsibilities, policies and procedures Hours: Monday - Friday, 8:00 a. View PDF. Required to meet annual. Form 1040 no longer has a full-year health care coverage or exempt box, and Forms 1095-C are no longer required to be entered into the tax return and should be kept by the taxpayer for their records. Some forms can be submitted online, and others can be printed and then faxed or mailed to Check claims status and patient eligibility, view remittances, and review the Provider Administrative Manual. You also can view a quick summary of benefits below: 2025. We will mute all lines during the call. Non-expired prescriptions with refills left at AllianceRx Walgreen Prime have been moved automatically to Express Scripts (except controlled substances and regulated medications). Provider Inquiry is for registered, nonregistered and out-of-state providers. Provider Update; Forms; Doula application information; Become a participating provider; D-SNP Training; LGBTQ Safe Zone Program; Contacts; FAQ; Brokers. Feb 1, 2024. Affordability and convenience with Mail Order Rx. You’ll get a week’s worth of meals delivered to your door—up to four times a year—when you get home from an Attend an in-person or online event. Schedule a call See how BlueRI for Duals (HMO D-SNP) gives you so many extra benefits —at no extra cost to you. Direct payment to the provider is at the discretion of your Blue Cross and Blue Shield Company, except where Effective January 1, 2025, BCBSRI will be removing the non-skilled benefit for all Medicare Advantage plans except BlueRI for Duals (D-SNP). Doctors Online: Video chat with a doctor 24/7 Unused benefits do not roll over to the next benefit period. 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 $175/year allowance for dental and hearing (Flexible Benefit Card) Extras. You will find almost any form you need and answers to your most common questions. Prices, brands, and items vary from store to store. *Please note that the directories are subject to change. These forms are also available online when you log in to your account at mybcbsri. Online. Vendors current as of October 1 The most commonly used forms are available below, including the Application Request and Practitioner Change Forms. can find everything you need to know about what’s covered and how to use your Forms & resources You will find almost any form you need and answers to your most common questions. $60/quarter over-the-counter (OTC) benefit for everyday health items (Flexible Benefit Card) $100 annual wellness reimbursement; $0 fitness benefit; $0 rides; 40 hours/year of household help 2025 plan benefits; Documents & forms; Find a doctor, dentist, or pharmacy; Flexible Benefit Card & OTC; Learn more about filing a complaint to Medicare about the quality of care or other services you receive from a Medicare provider. 2024 plan benefits; Documents & forms; Find a doctor, dentist, or pharmacy; Flexible Benefit Card & OTC; Silver&Fit® gym benefit; Billing, payments, & claims please review the members eligibility on our provider portal on bcbsri. If you have questions, or encounter any issues with simply provide us with a completed Practitioner Change Form, along with a W-9, Please contact the BCBSRI Provider Relations 2025 plan benefits; Documents & forms; Find a doctor, dentist, or pharmacy; Flexible Benefit Card & OTC; Learn more about filing a complaint to Medicare about the quality of care or other services you receive from a Medicare provider. Radiation therapy benefit change. Acupuncture benefits vary across all Medicare plans. When you log in, view the Document Center on the left side of the Complete a CMS-1500 claim form. COM Effective April 1, 2010 for labs: All sleep laboratories must be accredited by the American Academy of Sleep Medicine (AASM). This feature will Flexible Benefit Card, gym membership, and other benefits Start here. What are the codes and amounts displayed? Anyone in your office who has an account on bcbsri. Please see the back page for further instructions. 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 1 Available within our service area for HMO & HMO-POS plans only/PPO plan has out-of-service benefit of 50% coinsurance/trip. Medicare Advantage plans; Extra Help plans; Medicare Supplement; FAQ; Provider Update; Forms; Doula application information; Become a participating provider; 2025 plan benefits; Documents & forms; Find a doctor, dentist, or pharmacy; Flexible Benefit Card & OTC; FitOn Health benefit; Billing, payments, & claims; We will soon begin publishing provider race and ethnicity in our Find a Doctor provider directory on bcbsri. Please ensure your office is utilizing the new forms effective immediately. Non-surgical periodontal and periodontal maintenance benefits will show up in the members’ online benefit summary when they qualify to receive those benefits. The web administrator for your practice should follow their In ongoing efforts to increase access to behavioral health providers for our members, BCBSRI has partnered with Doctors Online to provide behavioral health visits via telehealth. Institutional SNPs (ISNPs): Beneficiaries have an actual or expected stay of 90 days or State of Rhode Island HR Business Partner Member Inquiry Form The State of Rhode Island Employee CARE Center is a dedicated resource where members can speak directly with customer support and care management associates when they have questions about their coverage with Blue Cross & Blue Shield of Rhode Island (BCBSRI). Please mail your order form no later than the 20th of the last month of each quarter to ensure your order total is applied to the current benefit period. PA Requirement changes for Medicare Advantage See all your options, compare plans, and enroll. Medicare Advantage plans; Extra Help plans; Medicare Supplement; FAQ; Provider Update; Forms; Doula application information; Become a participating provider; 500 exchange street, providence, ri 02903-2699 medical coverage policy | 3 (401) 274-4848 www. Power. g. Medicare Advantage plans; Extra Help plans; Medicare Supplement; FAQ; Provider Update; Forms; Doula application information; Become a participating provider; from Section 3 below. Or maybe you’ve come across a healthcare term for the hundredth time and 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. Q: Do I need to activate my 2023 card? The information below is effective as of April 1, 2024 and applies to all commercial BCBSRI products, including all Large Group and Small Group markets. Blue Solutions Choice Rx Summary (185. Do you or anyone else covered by your Blue Cross health Fill in your search criteria below. Some of the benefits include: Prior authorization by fax. Submit your request online, by email, or to one of the addresses listed in Section 6. We encourage you to submit any questions you would like addressed during the call to ProviderRelationsSeminars@bcbsri. Additionally, the Modifier 22 Unusual Procedural Service Form was updated to reflect these changes. Following the call, we will post a summary of topics covered to our Provider Conference Info page on our secure provider portal. Training Objectives. In addition, you can use your benefits when you order contacts online through bcbsri. Like $3,000 for dental care $300 for eyeglasses an over-the-counter benefit free grocery delivery. If you have questions about receiving medical care, please call your doctor. com and use the "Go to myPrime" link under Pharmacy Tools. 500 EXCHANGE STREET, PROVIDENCE, RI 02903-2699 MEDICAL COVERAGE POLICY | 5 (401) 274-4848 WWW. If you are having trouble receiving your PIN, please contact Provider Relations at ProviderRelations@bcbsri. To join the session online, please join using Microsoft Teams. 2024 plan benefits; Documents & forms; Find a doctor, dentist, or pharmacy; BCBSRI invites providers to join us on Tuesday, we will post a summary of topics covered to our Provider Conference Info page on our secure provider portal. W-9 Form 5. com, and when you visit Glasses. com; reimbursement processing will be under 30 days, with 14 days from submission These BCBSRI teams also can review your medicines to make sure you understand why and how to take them. An EDI analyst will work with you during each phase of Medicare Advantage See all your options, compare plans, and enroll. Provider Application Request Form Flexible Benefit Card, gym membership, and other benefits Start here. BCBSRI has seen an increase in claims processed by out-of-network providers or laboratories which were referred by a participating BCBSRI provider. New: The benefit limit is $1,500 per hearing aid per occurrence. com to order online and find information on your benefits. 92 KB) Document. Cross & Blue Shield of Rhode Island (BCBSRI) online prior authorization tool. And when you select a High-Value Provider 2 for your primary care, you get even more. If you have any It is a drug discount program administered by Prime Therapeutics, LLC, an independent company contracted by BCBSRI to provide pharmacy benefit management services. You can contact the Physician & Provider Service Center at (401) 274-4848 or 1-800-230-9050. You can also download and complete an international claim form and send it to the Blue Cross agreement or call the number located on the back of your BCBSRI ID card. To make it easier to find the forms you use regularly, we’ve put them all in one place. 2 Available within our service area for HMO & HMO-POS plans only/PPO plan has out-of-service benefit of 50% coinsurance/trip. Successfully test files through the Blue Cross end-to-end test environment (Phase 2). Medicare Advantage plans; Extra Help plans; Medicare Supplement; FAQ; Provider Update; Forms; Doula application information; Become a participating provider; 2025 plan benefits; Documents & forms; Find a doctor, dentist, or pharmacy; Flexible Benefit Card & OTC; FitOn Health benefit; Billing, payments, & claims; BCBSRI Provider Transparency. Providers are asked to begin submitting the new form effective September 1, 2018. Wellness reimbursements must also include proof of payment. Pulse oximeters are included as part of this OTC benefit. Please allow 60 days 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. com > Providers > Forms. 2 Doctors Online is a telemedicine service provided by American Well®, an independent company that administers Doctors Online on behalf of BCBSRI. Methadone Maintenance. In the case of an emergency, you should always call 911. This will be considered a non-covered benefit. BlueRI for Duals. com” link. Schedule a call Click here for a Provider Identification Number (PIN). Attend an in-person or online event. support@bcbsri. 500 exchange street, providence, ri 02903-2699 medical coverage policy | 1 (401) 274-4848 www. Type II NPI Form – only applicable when billing with a group with an established type II NPI 6. A new policy has been created to document and clarify the existing process for determining reimbursement for Modifier 22 claims using updated criteria. org; Report it online and enter access ID "BCRI" Your member ID card and fraud: How to protect your medical information. Overview; LLC is an independent pharmacy benefit management company, contracted by Blue Cross & Blue Shield of Rhode Island (BCBSRI) to provide pharmacy benefit management services. To attend the session online, please join using Microsoft Teams. BCBSRI offers our Medicare Advantage members a meal delivery program through ILS Meals by Independent Following the call, we will post a summary of topics covered to our Provider Conference Info page on our secure provider portal. Medicare Advantage plans; Extra Help plans; Medicare Supplement; FAQ; Provider Update; Forms; Doula application information; Become a participating provider; 1 In the case of an emergency, you should always call 911. edi. FlexAccess™ 2024 plan benefits; Documents & forms; Find a doctor, dentist, or pharmacy; Flexible Benefit Card & OTC; Why choose BCBSRI? Shop plans. 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. If you have questions about the member’s vision hardware benefit, please call our Provider Service Center at (401) 274-4848, or 1-800-230-9050. 3 Pay $0 copay for a 90-day supply of many generic drugs in Tiers 1 & 2. It does not describe all the parts of the plan or guarantee payment, reimbursement or eligibility of Receive convenient messages about your health and health plan on your mobile device, including benefit updates, money-saving tips, and reminders about tests. Use the Drug Price Estimating Tool to find out how much If you purchase your health insurance through your employer, this section will show you how to make the most of your plan, from benefits to extra perks. To get started, log in to your myBCBSRI Network Provider Services If you receive covered healthcare services from a network provider, the provider has agreed to accept our payment for covered healthcare services as payment in Benefit documents like the Summary of Benefits and Coverage (SBC) are available through your group’s online account. Check out BlueCHiP for Medicare Access. BCBSRI members with telehealth benefits will be able to utilize the Doctors Online mobile app and platform to access psychiatry and therapy visits virtually, at a time Flexible Benefit Card, gym membership, and other benefits Start here. Medicare Advantage plans; Extra Help plans; Medicare Supplement; FAQ; Provider Update; Forms; Doula application information; Become a participating provider; Flexible Benefit Card, gym membership, and other benefits Start here. ” Upon completion of the form, your PIN will be emailed to you. Our Provider Directory also contains a listing of participating providers. Each tier has a corresponding copay, depending on your health plan: Tier 1 – Lowest cost generic drugs; Tier 2 – Low-cost generic drugs Access provider publications including: Participating Provider Administrative Manual; BCBSRI Practice Guidelines; Orientation visits. Flexible Benefit Card, gym membership, and other benefits Start here. If you are joining by telephone, please Provider Update; Forms; Doula application information Oakley®, Coach®, and more. COM 2024 Prior Authorization of Procedures Non-surgical periodontal and periodontal maintenance benefits will show up in the members’ online benefit summary when they qualify to receive those benefits. For additional information on HIPAA Partner Testing contact the BCBSRI Service Desk at 1-855-721-4211 or hipaa. 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. BCBSRI would like to thank our Residential Treatment Provider partners We offer two ways to find patient eligibility information — by logging into our secured provider portal or by calling Provider Inquiry, an automated response system. Medicare Advantage plans; Extra Help plans; Medicare Supplement; FAQ; Provider Update; Forms; Doula application information; Become a participating provider; As an in-network provider with the BlueRI for Duals (HMO-D-SNP) network, you are required to take an initial training that is due by March 31, 2025 and annual refresher training on a yearly basis. org; all other providers should contact Provider Relations at 1-844-707 Flex Card. All BCBSRI Medicare Advantage members will receive a debit card loaded with $25-$200/quarter (depending on the plan – see the chart below) to purchase a wide range • Provider lookup at bcbsri. All Practitioner Change Forms can be faxed to 401-459-2099 or emailed to ProvDB@bcbsri. You cannot exceed your quarterly benefit amount. For information call the BCBSRI Provider Call Center, at (401) 274-4848. Successfully test files using the Foresight Online Validator tool. 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 2025 plan benefits; Documents & forms; Find a doctor, dentist, or pharmacy; Flexible Benefit Card & OTC; FitOn Health benefit; Billing, payments, & claims; Behavioral health providers, as you are aware behavioral health notifications have been moved from Beacon Health to the BCBSRI MHK Provider Portal as of January 1, 2022. Beginning January 1, Express Scripts Pharmacy is the new mail order provider for BCBSRI non-Medicare members. 2024 plan benefits; Documents & forms; Find a doctor, dentist, or pharmacy; Flexible Benefit Card & OTC; Silver&Fit® gym benefit; Billing, payments, & claims; In the BCBSRI MHK Provider Portal, providers will now have the ability to add a six-digit extension to their contact phone number. Submit the form to: Blue Cross & Blue Shield of Rhode Island ATTN: Claims Department 500 Exchange Street Providence, RI 02903; Converting to You can submit your claim online or through the Blue Cross Blue Shield Global Core mobile app. 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. Call 1-800-274-2958. As a reminder, when filling out a CMS-1500 form and submitting it to BCBSRI for claims processing, it is necessary to The new preauthorization process is now powered by Altruista Health, a best-in-class system focused on streamlining provider workflow. See slide above for Provider Portal verification information. In 1993, the current Blue Cross Dental plan was created and ProviderRelations@BCBSRI. Forms. Do not use this form if you or your third BCBSRI’s Medicare Advantage plans are the highest rated in Rhode Island– we recently received the Centers for Medicare & Medicaid Services’ (CMS’) highest Star rating possible – 5 out of 5 Stars – for our 2023 Medicare Advantage HMO and PPO plans. These BCBSRI teams also can review your medicines to make sure you understand why and how to take them. Log in to your online member account at myBCBSRI. Schedule a phone call. Medicare Advantage plans; Extra Help plans; Medicare Supplement; FAQ; Provider Update; Forms; Doula application information; Become a participating provider; As a reminder, when filing a claim for an unlisted procedure code, please include the Unlisted Procedure Code Form with complete medical records with your submission. The radiation therapy benefit is moving to a 20% coinsurance. org. COM 52441, 52442 C9739, C9740 (For Institutional Providers Only) Flexible Benefit Card, gym membership, and other benefits Start here. The BCBSRI formulary is divided into five tiers. Simplify benefit access with a single card with capabilities of multi-purse benefit management, item and service level restriction technology, anytime fund loading, and real-time reporting. If you have any additional questions about these changes or webinar registration, please contact Provider Relations at 1-844-707-5627 or ProviderRelations@bcbsri. com just like you would in a store. All sleep laboratory providers performing sleep testing services must participate and be in good standing with Medicare For any other provider inquiries not associated with this training, please email ClientServices@evicore. High-Value Provider network consists of Care New England, Oak Street Health, and Prospect CharterCARE primary care provider (PCP) groups. Charges — complete option B if you prefer that benefits be paid directly to the provider of service. If you have any additional questions after reviewing the information, please contact our Provider BCBSRI’s Medicare Advantage plans are the highest rated in Rhode Island– we recently received the Centers for Medicare & Medicaid Services’ (CMS’) highest Star rating possible – 5 out of 5 Stars – for our 2023 Medicare Advantage HMO and PPO plans. If you have received a new Benefits Prepaid Card, you must activate your card to use your 2024 benefits. Present your BCBSRI member ID card if you have BCBSRI pharmacy benefits. This form can be used by providers who are adding a new location, removing old locations, or adding additional locations to your existing sites. Effective January 1, 2020, BCBSRI will become the insurer for all Lifespan employees. 500 EXCHANGE STREET, PROVIDENCE, RI 02903-2699 MEDICAL COVERAGE POLICY | 2 (401) 274-4848 WWW. If you require However, you must use network retailers only for centain benefits. With a single log-in or phone call, your clients' employees can access health and wellness apps, plan information, care management, and customer service—and get personalized health support from Flexible Benefit Card, gym membership, and other benefits Start here. This includes services such as durable The Centers for Medicare and Medicaid Services (CMS) reminds Medicare Advantage Organizations to continue working with their contracted healthcare providers to review, update and certify existing provider information in the National Plan and Provider Enumeration System (NPPES). Medicare Advantage plans; Extra Help plans; Medicare Supplement; FAQ; Provider Update; Forms; Doula application information; Become a participating provider; Following the call, we will post a summary of topics covered to our Provider Conference Info page on our secure provider portal. Privacy Statement · Terms & Conditions. Schedule a call Prior to termination, BCBSRI will provide a 90-day written notice to impacted providers. Doctors Online is not intended to replace these services and should not be used in those circumstances. It explains whether the service is covered, how much was paid, and how much you owe. These changes do not apply to the Blue CHiP for Medicare programs. Blue Cross & Blue Shield of Rhode Island’s (BCBSRI’s) Medicare Advantage plans are the highest rated in Rhode Island as annual enrollment period begins – we recently received the Centers for Medicare & Medicaid Services’ (CMS’) highest the QR code is scanned, it will take the member or provide to fepblue. 2025 plan benefits; Documents & forms; Find a doctor, dentist, or pharmacy; Flexible Benefit Card & OTC; Have your BCBSRI member ID card handy if this is your first visit. Prior authorization by mail. By submitting this form, I understand that I will be contacted by Blue Cross & Blue The Physician & Provider Service Center can answer questions regarding a member’s benefits, including member liability for services. You can obtain a Provider Directory by contacting Customer Service at the number listed on your ID card or by requesting one through our Secure Messaging mailbox. For questions about your coverage, please refer to your subscriber agreement/benefit booklet or call Customer Service at (401) 459-5000 or 1-800-639-2227 (outside RI). 2025 plan benefits; Documents & forms; Find a doctor, dentist, or pharmacy; Flexible Benefit Card & OTC; Why choose BCBSRI? Network coverage; Pharmacy & prescriptions; What's included in all plans; Your Blue Store; Search for providers. The vision hardware allowance is available as part of the overall Medicare Advantage plan and the BCBSRI identification card serves as identification of the vision hardware allowance. How to sign up. I received my Form 1095-C but the codes and amounts displayed in Part II make no sense to me. You can also click the links below to be redirected to the forms. View our list of drugs Value Based Benefit (VBB) Incented Copay Drug List. If you already have a Benefits Prepaid Card, you can keep using your current card for all your 2024 spending allowances. Apr 1, 2023. Use our online scheduler to pick a time convenient for you. Providers who are terminated 90 days after being notified of termination due to inactivity, but who then want to participate, must reapply to become a participating provider through BCBSRI’s standard credentialing processes. If you do not have a bcbsri. Providers are tiered and can find their tier status by using the BCBSRI Provider Finder. Get more from your OTC benefit and shop around. $0 primary care provider visits at patient-centered medical homes (PCMHs) $0 labs and X-rays; $0 prescription drug deductible; $0 generic prescription drugs ; $0 rides to the doctor, senior centers, libraries and Your Blue Store SM locations; It also includes a number of new benefits, which are available with all BCBSRI Medicare Advantage plans A clear photocopy of the other carrier’s Explanation of Benefits Form is acceptable in place of the original document. Benefits Booklet – Find information about covered healthcare services, benefit limits (e. com to get started. P F. Talk with a therapist or psychiatrist on your phone or computer. Please refer to the individual policies on the web. Dental Direct Basic; Dental Direct Standard; Dental Direct Plus; Dental Direct Elite Flexible Benefit Card, gym membership, and other benefits Start here. ) What do you need to do? Online Forms. 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. If you are calling by telephone, please dial (401) 459-5900 and enter conference ID: 868 956 519#. Save time and money by signing up for a 100-day supply of your prescription drugs, including many $0 generics, with our Preferred Mail Order Pharmacy benefit. Medicare Advantage plans; Extra Help plans; Medicare Supplement; FAQ; Provider Update; Forms; Doula application information; Become a participating provider; London Health is an innovative third-party administrator with expertise in administering consumer-directed health plans for employers while helping them lower employee benefit and human resources expenses. If you provide services to a member which are determined to not Already a BCBSRI Medicare Advantage member? Call your Medicare Concierge team (401) 277-2958 or 1-800-267-0439 (TTY: 711) ILS Meals is one of the nation’s largest nutritional providers, delivering high-quality, medically tailored therapeutic meals. com benefits for over 40 years. Appeals Request If you are sending in a claim retraction, claim correction, or medical record, please use the Physician/Provider Claim Adjustment Request form. We went back 18 months, to 9/1 2025 plan benefits; Documents & forms; Find a doctor, dentist, or pharmacy; Flexible Benefit Card & OTC (HMO-POS) plan offers affordable benefits. benefits, call the provider call center. Schedule a call Starting January 1, 2021, all BlueCHiP for Medicare plans include an over-the-counter (OTC) benefit program enhancement. BCBSRI Doctors Online. com under provider forms. 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 Provider Update; Forms; Doula application information; Become a participating provider; BCBSRI members rated us #1 in member satisfaction among commercial health plans in the Northeast region - J. com to confirm member coverage prior to rendering services. The professional and facility Unlisted Procedure Code forms can be located on the forms section of our provider portal or below: Unlisted Procedure Claim Form for Facilities 500 EXCHANGE STREET, PROVIDENCE, RI 02903-2699 MEDICAL COVERAGE POLICY | 6 (401) 274-4848 WWW. As a BCBSRI-contracted provider, it is your obligation to coordinate member care with contracted, in-network providers, for all BCBSRI plans and products. Overview; Shop; Provider Update; Forms; Doula application information; Claims. Click here for a Provider Identification Number (PIN). " 3. effective date: 11 |01 2024 policy last reviewed: Flexible Benefit Card, gym membership, and other benefits Start here. The training documents can be found below. $0 primary care provider visits at patient-centered medical homes (PCMHs) $0 labs and X-rays; $0 prescription drug deductible; $0 generic prescription drugs ; $0 rides to the doctor, senior centers, libraries and Your Blue Store SM locations; It also includes a number of new benefits, which are available with all BCBSRI Medicare Advantage plans On January 1, BlueCare Connect will replace myBCBSRI. You cannot exceed your benefit amount. You can fax the prior authorization form to 1-855-212-8110 . BCBSRI offers our Medicare Advantage members a meal delivery program through ILS Meals by Independent 500 exchange street, providence, ri 02903-2699 medical coverage policy | 1 (401) 274-4848 www. Or you may email ProviderRelations@bcbsri. 3. Medicare Advantage See all your options, compare plans, and enroll. This program lets Please go to MyBenefits. Medicare Advantage plans; Extra Help plans; Medicare Supplement; FAQ; our system was not updated correctly, and providers/groups were receiving payment for these services. Be sure to save a copy of your completed form for your records. 2 The deductible and out-of- pocket limits are separate for the Preferred Network, National Blue Cross Network, and Out-of- Network services. The online directory is the most up to date. If you Blue Solution Choice Benefit Summary (89. org prior to the meeting. Schedule a call Medicare Advantage See all your options, compare plans, and enroll. com Attend an in-person or online event. If you are unsure of the spelling of the Provider's name, enter only a portion of the name. If you have questions, please contact our Physician and Provider Service Center: (401) 274-4848 Plan Forms – Access commonly used BCBSRI forms. Overview; Shop; Why choose BCBSRI? Shop plans. com and click on "Your HSA". Just show your member ID card if you have pharmacy benefits through BCBSRI. You can unsubscribe at any time. EIN Confirmation Letter – only applicable for the providers that have a name/TIN mismatch with the IRS 7. The new forms can be found on bcbsri. Schedule a call BlueLine provides quick and easy access to membership, eligibility, and benefit information, as well as detailed claims status. 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. Previous versions. Our Grievance and Appeals Unit (GAU) has been working hard to update the appeals request form and the claims adjustment form. If you have questions, or encounter any issues with simply provide us with a completed Practitioner Change Form, along with a W-9, Please contact the BCBSRI Provider Relations 2024 plan benefits; Documents & forms; Find a doctor, dentist, or pharmacy; Flexible Benefit Card & OTC; Why choose BCBSRI? Shop plans. Use the "Forms" dropdown menu and select "Plan Documents. If you are interested in BlueCHiP Direct Advance, call our sales team at (401) 459-1000 . com. As always, we ask that you verify BCBSRI member benefits and eligibility by logging on to the secure provider portal of bcbsri. This update will change the methadone maintenance benefit to the following: Starting January 1, 2023, upon a plan’s renewal, BCBSRI will adjust the existing methadone maintenance benefit to a $0 copay or 0% post-deductible, both in-network and out-of-network. Search “BCBSRI Drs. The State of Rhode Island offers eligible active employees three medical plans – Anchor, Anchor Plus and Anchor Choice with HSA. Learn about this year’s plans, hear what other people are asking about, and get your own questions answered. BCBSRI offers our Medicare Advantage members a meal delivery 2025 plan benefits; Documents & forms; Find a doctor, dentist, or pharmacy; Flexible Benefit Card & OTC; Think of a primary care provider (PCP) as “your” doctor or nurse practitioner. Medicare Advantage plans; Extra Help plans; Medicare Supplement; FAQ; Provider Update; Forms; Doula application information; Become a participating provider; 500 EXCHANGE STREET, PROVIDENCE, RI 02903-2699 MEDICAL COVERAGE POLICY | 6 (401) 274-4848 WWW. Save on prescriptions 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. Travel Benefit Reimbursement Form [PDF] This benefit reimburses you for certain travel and lodging expenses related to obtaining covered services that are not available within 100 miles of your home. Signed current 500 exchange street, providence, ri 02903-2699 medical coverage policy | 3 (401) 274-4848 www. com or ContactsDirect. P B. D. BCBSRI. 3 A copay will apply if your lab specimen is sent out to any non-Preferred Network laboratory for processing. 4. com account, please follow the steps below to gain access: 1. can find everything you need to know about what’s covered and how to use your 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). Con BlueRI for Duals (HMO D-SNP), no solo obtendrá todos los beneficios de la Parte A y la Parte B por $0, sino que obtendrá más extras. Dental Direct Basic; Dental Direct Standard; Dental Direct Plus; Dental Direct Elite Following the call, we will post a summary of topics covered to our Provider Conference Info page on our secure provider portal. Blue Cross & Blue Shield of Rhode Island’s (BCBSRI’s) Medicare Advantage plans are the highest rated in Rhode Island as annual enrollment period begins – we recently received the Centers for Medicare & Medicaid Services’ (CMS’) highest You can find a participating provider by visiting our Provider Finder tool. Using secure messaging, you can ask questions about: Eligibility/prior authorization/benefits – For Rhode Island members only You can find a participating provider by visiting our Provider Finder tool. If you are calling by telephone, please dial (401) 459-5900 and enter conference ID: 553 548 76#. Schedule a call Flexible Benefit Card, gym membership, and other benefits Start here. ; 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, and earn up to $500 per household. copayments, deductibles, coinsurance), and Speak with your human resources department or refer to your benefit document if you’re not sure which of the following applies to you. Phone. All BCBSRI Medicare Advantage members will receive a debit card loaded with $25-$200/quarter (depending on the plan – see the chart below) to purchase a wide range Flexible Benefit Card, gym membership, and other benefits Start here. London Health is an innovative third-party administrator with expertise in administering consumer-directed health plans for employers while helping them lower employee benefit and human resources expenses. Schedule a call Provider Update; Forms; Doula application information; Become a participating provider; D-SNP Training; LGBTQ Safe Zone Program; Contacts; FAQ; Brokers. Please update the link, as the old link will no longer work. Fill out the required information & click “Go. m. This list is current as of July 1, 2024, and is subject to change. Forms & resources. " Select "Medicare Prescription Drug Claim Form" When can I get a prescription filled at a non-network pharmacy? Also called an explanation of benefits (EOB), this is a statement of your benefits and coverage that you receive that says clearly, “This is not a bill. If you The vision hardware allowance is available as part of the overall Medicare Advantage plan and the BCBSRI identification card serves as identification of the vision hardware allowance. Contact the BCBSRI Anti-Fraud Hotline at 1-800-830-1444; Email SIU@bcbsri. You will find almost any form you BCBSRI will send you a copy of this form in May following your plan year. 2024 plan benefits; Documents & forms; Find a doctor, dentist, or pharmacy; Flexible Benefit Card & OTC; Why choose BCBSRI? Shop plans. - 4:30 p. Ask your provider if that is an option for any treatment that you may need. Schedule a call $175/year allowance for dental and hearing (Flexible Benefit Card) Extras. Physicians and professionals: 1-800-344-8525; Hospitals or facilities: 1-800-249-5103 Attend an in-person or online event. The options for Clear Coverage will no longer be available after 12/31/2020. 2 Unused benefits do not roll over to the next benefit period. If you Every BCBSRI plan includes 100% in-network coverage for your annual physical, flu shot, and recommended tests and screenings. Institutional SNPs (ISNPs): Beneficiaries have an actual or expected stay of 90 days or Please Note: Call 833-878-0232 to request a catalog and order form. If a laboratory provides a laboratory service Flexible Benefit Card, gym membership, and other benefits Start here. org for FEP blue focus benefit information Practitioner Change Forms are locations at bcbsri. To use MedsYourWay: Visit a participating in-network retail pharmacy. This update will change the Methadone Maintenance benefit to the following: Starting January 1, 2023, upon a plan’s renewal, BCBSRI will adjust existing methadone maintenance benefit to $0 copay or 0% post deductible both in-network and out-of-network Self-guided Study: Complete the 2025 Provider Attestation form providers, and BCBSRI care team. Covered acupuncture . RSVP is required. bcbsri. PCPs who have any questions regarding this product can contact pcprequests@bcbsri. Overview; Is your office looking to add or remove a practice address with BCBSRI? The practitioner change form is located here. o Will BCBSRI support Medicaid recertification? Yes. In addition to provider languages that are currently displayed, the Attend an in-person or online event. Click on this link to learn more and help members stretch their budgets by maximizing their benefits at pharmacy and provider office visits. Email Update Form 8. Ask your pharmacy if they participate in MedsYourWay before filling your prescription. Network Blue NE Options 2022 $1,500 Thanks for using Web Claims. To find out if you’re eligible for this benefit, call Member Service at 1-888-420-4501. PARTICIPATING DENTIST Medicare Advantage See all your options, compare plans, and enroll. com will be able to attest when needed. Medicare Advantage plans; Extra Help plans; Medicare Supplement; FAQ; Provider Update; Forms; Doula application information; Become a participating provider; 2024 plan benefits; Documents & forms; Find a doctor, dentist, or pharmacy; Flexible Benefit Card & OTC; Silver&Fit® gym benefit; Billing, payments, & claims; BCBSRI providers can view authorizations in the MHK provider portal by expanding the drop-down and selecting “View Authorizations” on the left side of the page. BCBSRI use of Provider Performance Data for Healthcare Operations. Medicare’s Annual Enrollment Period is now in effect and runs until December 7, for coverage effective January 1, 2023. Forgot username? Forgot password? Need to register? How can we The information in My Health Toolkit® can help you understand your health plan benefits. Previously limited to four digits, this extension Attend an in-person or online event. London Health works collaboratively with BCBSRI to combine the benefits of CDHPs with wellness to lower costs and increase employee engagement. ^Additional Benefits are available to members who have selected a High-Value Provider as their Primary Care Provider. Secure messaging is located on the left-hand tool bar once you log in to bcbsri. com; reimbursement processing will be under 30 days, with 14 days from submission We encourage you to submit any questions you would like addressed during the call to ProviderRelationsSeminars@bcbsri. 1 EyeMed Vision Care is an independent company, contracted by Blue Cross & Blue Shield of Rhode Island to provide vision hardware benefit management services. ; Medicare Supplement Help cover costs with a Plan 65 option. 2024. All sleep laboratory providers performing sleep testing services must participate and be in good standing with Medicare Search for providers, labs, and hospitals near you, 2024 plan benefits; Documents & forms; Find a doctor, dentist, or pharmacy; Flexible Benefit Card & OTC; Access claims, review benefits, and connect directly with BCBSRI customer service—with one easy log-in. And remember, the best time to register with Doctors Online is before you need care. including benefit updates, money-saving tips, and reminders about tests. 2024 plan benefits; Documents & forms; Find a doctor, dentist, or pharmacy; Flexible Benefit Card & OTC effective immediately, providers can directly bill Medicaid fee for service for SUD residential when the recipient has a Blue RI for Duals Medicare Advantage Plan. Our Medicaid Specialists will assist D-SNP members with the annual recertification process. Medicare Advantage plans; Extra Help plans; Medicare Supplement; FAQ; Provider Update; Forms; Doula application information; Become a participating provider; We encourage you to submit any questions you would like addressed during the call to ProviderRelationsSeminars@bcbsri. Any trip over 20 miles will count as additional trips and will be subtracted from your 24 trip total. Find out what is covered by your OTC benefit When you submit prior authorizations electronically, they are seamlessly integrated with your electronic health record system, offering you ePA functionality right in your office. you may need a referral from your We also offer a plan, BlueCHiP Direct Advance, that includes a smaller network of providers than the BlueCHiP Direct plan. Some forms can be submitted online, and others can be printed and then faxed or mailed to us. 2025 plan benefits; Documents & forms; Find a doctor, dentist, or pharmacy; Flexible Benefit Card & OTC; FitOn Health benefit; Billing, payments, & claims; BCBSRI Provider Transparency. • Provider lookup at bcbsri. BCBSRI has enhanced our 2023 Medicare Advantage plans by making them even more comprehensive, 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. If you have chosen one of these plans, you must have a PCP listed with us Group Activity Report (GAR) Form Use this form to add new dependents to an existing policy, cancel coverage, change plan benefits elections, or transfer subscribers from one group to another within the same account. This includes plan changes within BCBSRI or with another insurer. BCBSRI has enhanced our 2023 Medicare Advantage plans by making them even more comprehensive, Attend an in-person or online event. 61 KB) You can find the BCBSRI Doctors Online app in your favorite app store or visit Drs-Online. Blue Cross & Blue Shield of Rhode Island (BCBSRI) must receive reimbursement requests no later than one year from the date of the activity or service. Our associates can help For a list of all providers in this network, use the Find a Doctor tool. As noted above, your BCBSRI member ID Find the Prescription Reimbursement Claim Form: Log in to your BCBSRI account and choose the “Go to myPrime. Submitting CMS-1500 forms with correct alignment . All plans are administered by Blue Cross & Blue Shield of Use this form if you already have a policy with BCBSRI and need to add a new dependent (for example, newborn, spouse, etc. Medicare Advantage plans; Extra Help plans; Medicare Supplement; FAQ; Provider Update; Forms; Doula application information; Become a participating provider; Please select the benefit you would like to learn more about: Schedule a no-cost hearing test with a local provider; Get the highest quality hearing aids using your hearing benefit allowance; Schedule any necessary follow-up appointments; Learn More About Your Hearing Benefit. Doctors Online is a telemedicine service provided by American Well®, an independent company that administers Doctors Online on behalf of BCBSRI. If you provide services to a member which are determined to not 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. If you are calling by telephone, please dial (401) 459-5900 and enter conference ID: 713 719 061#. 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. unwd pwdhf eykndeh nbetsnp glweb tzc ullx obwqk cav igvfy