What types of policy changes does Blue Cross Blue Shield of Rhode Island issue?

Blue Cross Blue Shield of Rhode Island regularly publishes coverage updates including prior authorization requirement changes, billing code additions or deletions, plan-type coverage modifications, and clinical policy revisions. PolicyChanges.app monitors these notices and summarizes the impact for providers.

How often does Blue Cross Blue Shield of Rhode Island update its policies?

Blue Cross Blue Shield of Rhode Island typically releases policy bulletins on a rolling basis throughout the year. Our system checks for new updates daily and adds them to this feed as soon as they are identified.

What should I do when Blue Cross Blue Shield of Rhode Island changes a prior authorization policy?

Review each change's effective date and action-required notes. Update your billing and clinical workflows before the effective date to avoid claim denials. Each policy detail page on PolicyChanges.app includes a plain-English summary and action items.

PAYER POLICY CHANGES

Blue Cross Blue Shield of Rhode Island Policy Changes & Prior Auth Updates

Q: How many Blue Cross Blue Shield of Rhode Island policy changes are tracked here?

This page currently tracks 50 documented Blue Cross Blue Shield of Rhode Island policy changes. New items are added as they are identified.

We track 50 documented policy changes from Blue Cross Blue Shield of Rhode Island across AR, CA, CT, IL, MA and 5 more states. Each entry includes an AI-generated plain-English summary, effective date, affected billing codes, and a direct link to the original Blue Cross Blue Shield of Rhode Island notice. Use the related links below to narrow results by specialty or state, or create a free alert to get new Blue Cross Blue Shield of Rhode Island updates by email (daily or weekly, your choice, on every plan).

Blue Cross Blue Shield of Rhode Island · Effective Jan 1, 2027High impact
Medical policy updates
BlueCross BlueShield of Rhode Island's November 2026 update changes prior authorization and coverage for many lab, genetic and imaging services, most of them effective January 1, 2027 for Medicare Advantage and commercial plans, including removing prior authorization for many biomarker testing codes and adding prior authorization for CPT 0154U. It also adds a physical and occupational therapy review after the 14th visit per episode for fully funded commercial plans at renewal on or after January 1, 2027, and it recorded a November 1, 2026 change that keeps the online tool criteria for shoulder replacement codes while the new draft policy is on hold.
Blue Cross Blue Shield of Rhode Island · Effective Jan 1, 2027High impact
Payment policy updates
BCBS Rhode Island issued multiple payment policy updates with staggered effective dates: pharmacy MPS lists updated (October 1, 2026—already effective), CPT 87494 (STI testing) added to preventive benefits (January 1, 2026—already effective), fee-based PCP attribution policy updated per state regulation (September 21, 2026 bulletin), and maternity/OB services billing fundamentally restructured from bundled to unbundled codes effective January 1, 2027. The OB policy change requires providers to bill individual E&M and delivery codes instead of global OB packages starting 2027.
Blue Cross Blue Shield of Rhode Island · Effective Jan 1, 2027High impact
Maternity - Obstetrical Services
BCBS RI is discontinuing bundled obstetrical billing effective January 1, 2027. Providers must transition from current bundled OB codes to individual Evaluation and Management and delivery codes per new AMA/CPT coding standards. Current bundled codes will be deleted December 31, 2026.
Blue Cross Blue Shield of Rhode Island · Effective Jan 1, 2027High impact
PT/OT prior authorization to expand on January 1, 2027
Effective January 1, 2027, BCBSRI will expand eviCore's prior authorization management to include physical and occupational therapy services for fully insured commercial members. Notification will be required for PT/OT visits 1–14 per episode of care; prior authorization will be required beginning with the 15th visit. All affected codes will be outlined in the updated medical policy 'Prior Authorization of Physical and Occupational Therapy Services.'
Blue Cross Blue Shield of Rhode Island · Effective Dec 1, 2026Medium impact
Medical policy updates
Blue Cross Blue Shield of Rhode Island's October 1, 2026 medical policy update changes several effective-December 1, 2026 rules for Medicare Advantage and commercial plans. The biggest moves are coverage changes for specific lab tests (several become not covered or not medically necessary, and others gain or lose prior authorization), a new covered diagnosis list for corneal topography, and coverage for two back pain procedures on Medicare Advantage plans only. Lab, imaging and procedure billing teams should update their tests and authorization workflows before December 1, 2026.
Blue Cross Blue Shield of Rhode Island · Effective Jan 1, 2027Medium impact
January 2027 Summary of Changes - Pharmacy
BCBS Rhode Island is updating preferred product selections for four commercial medical drug categories effective January 2027. Related prior authorization, step therapy, and policy materials will be aligned with these new preferred product selections. The specific drug categories and products are not detailed in this summary notice.
Blue Cross Blue Shield of Rhode Island · Effective Jan 1, 2027Medium impact
Subject: CMS-0057 Electronic Prior Authorization – Provider Readiness and Onboarding
Blue Cross & Blue Shield of Rhode Island (BCBSRI) is implementing electronic prior authorization capabilities under the CMS-0057 Interoperability and Prior Authorization Final Rule, effective January 1, 2027. Providers must identify appropriate EHR, IT, and operational contacts and begin onboarding coordination to support electronic prior authorization and provider access capabilities through their EHR systems.
Blue Cross Blue Shield of Rhode Island · Effective Jan 1, 2027Medium impact
Network Updates
Effective January 1, 2027, BCBSRI will expand in-network behavioral health specialty coverage for the BlueCHiP Direct Advance product and introduce a new limited network product called BlueCHiP Select RI. Billing teams must verify network status and update provider directories for behavioral health claims submitted under these plans starting in 2027.
Blue Cross Blue Shield of Rhode Island · Effective Jan 1, 2027Medium impact
InterQual updates
Blue Cross Blue Shield Rhode Island (BCBSRI) will update InterQual Criteria for CP (Procedures) related to Unicondylar or Patellofemoral Knee Replacement effective January 1, 2027. Billing and clinical teams should obtain the updated criteria from ProviderRelations@bcbsri.org to ensure compliance with new utilization review requirements.
Blue Cross Blue Shield of Rhode Island · Effective Jan 1, 2027Medium impact
CMS-0057 Electronic Prior Authorization – Provider Readiness and Onboarding
BCBSRI is implementing electronic prior authorization capabilities compliant with CMS-0057 Interoperability and Prior Authorization Final Rule, effective January 1, 2027. Providers must identify appropriate contacts and confirm EHR readiness for electronic prior authorization exchange to support the transition.
Blue Cross Blue Shield of Rhode Island · Effective Jan 1, 2027Low impact
Medicare ID cards for 2027
Starting with the 2027 plan year, BCBSRI Medicare Advantage members will only receive new ID cards if they experience a plan change or cost-share modification on their card. Members will retain their current year's card; duplicate cards remain available upon request through the Medicare Concierge team.
Blue Cross Blue Shield of Rhode Island · Effective Jan 1, 2027Low impact
Medicare ID Cards for 2027
Starting January 1, 2027, Blue Cross Blue Shield Rhode Island (BCBSRI) will no longer automatically issue new Medicare Advantage ID cards annually unless members have experienced a plan change or their cost-sharing information has changed. Members will retain their current year's card, though duplicate cards remain available upon request through the BCBSRI Medicare Concierge team.
Blue Cross Blue Shield of Rhode Island · Effective Nov 1, 2026High impact
Medical policy updates
This policy update consolidates multiple medical policies effective November 1, 2026, with key changes including: (1) molecular testing codes for pulmonary nodules moving to a separate biomarker policy with no coverage changes; (2) genetic testing for mental health conditions replacing an obsolete test with OptimalRx Plus (not covered for Medicare Advantage, not medically necessary for commercial); (3) shoulder joint replacement requiring prior authorization with revised medical criteria; (4) ProMark Risk Score policy consolidation with no coverage changes; and (5) removal of prior authorization for in-lab sleep studies (CPT 95805, 95808, 95810, 95811) for commercial products effective October 1, 2026. Additionally, Medicare Advantage coverage is now subject to change at Medicare's discretion for LTACH admissions.
Blue Cross Blue Shield of Rhode Island · Effective Oct 1, 2026High impact
BlueCHiP for Medicare national and local coverage determinations policy
BlueCHiP for Medicare will now strictly follow CMS National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs) rather than applying independent policy determinations. Many BCBSRI policies previously applicable to both commercial and Medicare products are now commercial-only; billing teams must consult BlueCHiP for Medicare's specific NCD/LCD policies for Medicare coverage decisions to avoid claim denials.
Blue Cross Blue Shield of Rhode Island · Effective Oct 1, 2026High impact
Payment policy updates
Two significant policy updates effective October 1, 2026: (1) Home health care therapy services (revenue codes 042X, 043X, 044X) now require specific therapy modifiers (GP for physical therapy, GO for occupational therapy, GN for speech-language pathology) appended to CPT codes, or claims will be denied; (2) Behavioral health collaborative care codes are no longer reimbursable for a comprehensive list of provider specialties including psychiatrists, psychologists, clinical social workers, and licensed counselors.
Blue Cross Blue Shield of Rhode Island · Effective Oct 1, 2026High impact
Payment Policy Updates
Effective October 1, 2026, Blue Cross Blue Shield Rhode Island has added 24 specific HCPCS and CPT codes to their non-reimbursable services list. Thirteen codes (A2046-A2050, A4228, A9613, E0788, L8697, Q4207, Q4223, Q4243) will be denied for facility claims only, while ten codes (T1069-T1078) will be denied for both professional and facility claims across all lines of business. Two orthotic codes (L1330, L1972) will be denied for professional and facility claims but remain reimbursable for DME professionals.
Blue Cross Blue Shield of Rhode Island · Effective Oct 1, 2026High impact
Provider notice: Benefit coverage change
Effective October 1, 2026, BCBSRI is moving coverage for six specific medications (Signifor LAR, Aralast NP, Glassia, Prolastin-C, Zemaira) from the pharmacy benefit to the medical benefit. All prior authorization requests for these drugs must now be submitted through GatewayPA using the medical benefit process instead of pharmacy benefit procedures.
Blue Cross Blue Shield of Rhode Island · Effective Oct 1, 2026High impact
Anthem Dual Par Issue
Anthem is denying claims for members who have dual par status, instructing providers to submit directly to Anthem instead of through the intermediary. For Anthem of Connecticut members, practices must verify with Carelon whether a direct Anthem contract exists. Incorrectly denied claims will be compiled into a monthly report by Anthem for reprocessing, with newer claims prioritized.
Blue Cross Blue Shield of Rhode Island · Effective Oct 1, 2026High impact
Requirement to refer members to in-network providers
BCBSRI is enforcing a requirement that all participating providers must refer members exclusively to in-network providers for all services including durable medical equipment, radiology, behavioral health, and laboratory/pathology services. The policy identifies four specific laboratories (Accu Reference Lab, Quest Diagnostics, Total Toxicology, U.S. Lab & Radiology, Inc.) that do NOT participate in BCBSRI's network and must be avoided for referrals.
Blue Cross Blue Shield of Rhode Island · Effective Oct 1, 2026High impact
SNF Home Health Agency coding
Effective October 1, 2026, BCBSRI will enforce a coding edit requiring therapy service modifiers (GP for physical therapy, GO for occupational therapy, GN for speech-language pathology) to be appended to CPT codes when submitted with SNF/home health agency revenue codes 042X, 043X, or 044X. Claims missing the required modifier or containing an incorrect modifier will be denied.
Blue Cross Blue Shield of Rhode Island · Effective Oct 1, 2026High impact
Payment policy updates
This policy package contains four separate updates effective October 1, 2026: (1) Home Health Care Services now require therapy service modifiers (GP, GO, GN) appended to revenue codes 042X, 043X, 044X or claims will be denied; (2) Behavioral Health Integration/Collaborative Care services are now restricted—12 provider types (psychiatrists, psychologists, LCSWs, LMHCs, LMFTs, LBAs, LCDPs, CNS, BH NPs, BH PAs, psychiatric neurologists, child/adolescent psychiatrists) are ineligible for reimbursement; (3) Early Intervention Services cost-sharing rules updated for high-deductible plans; (4) Pharmacy drug list updated for post-claim review. Immediate action required on modifier enforcement and provider eligibility.
Blue Cross Blue Shield of Rhode Island · Effective Oct 1, 2026High impact
Provider Notice: Benefit Coverage Change
Effective October 1, 2026, BCBSRI is moving coverage for six specialty medications (Signifor LAR, Aralast NP, Glassia, Prolastin-C, Zemaira) from the pharmacy benefit to the medical benefit. All prior authorization requests for these drugs must now be submitted through GatewayPA as medical benefit requests rather than pharmacy requests.
Blue Cross Blue Shield of Rhode Island · Effective Oct 1, 2026High impact
SNF HHA PT Coding
Effective October 1, 2026, BCBSRI will enforce a coding edit requiring therapy service modifiers (GP for physical therapy, GO for occupational therapy, GN for speech-language pathology) to be appended to CPT codes when billing with SNF/HHA therapy revenue codes 042X, 043X, or 044X. Claims missing the required modifier or containing an incorrect modifier will be denied.
Blue Cross Blue Shield of Rhode Island · Effective Oct 1, 2026High impact
Benefit Coverage Change for Medications
Effective October 1, 2026, BCBSRI is transitioning coverage for six specialty medications (Signifor LAR, Aralast NP, Glasssia, Prolastin-C, Zemaira) from the pharmacy benefit to the medical benefit. These medications will now require prior authorization through GatewayPA under the medical benefit instead of being processed as pharmacy claims.
Blue Cross Blue Shield of Rhode Island · Effective Oct 1, 2026High impact
Medical policy updates
This comprehensive policy update effective October 1, 2026, modifies coverage, prior authorization requirements, and billing procedures across 9 different medical services. Changes vary significantly by plan type (Medicare Advantage vs. Commercial), with some services moving from covered to non-covered, others gaining prior authorization requirements, and several undergoing administrative restructuring. Billing teams must implement plan-specific workflows immediately to avoid claim denials after the effective date.
Blue Cross Blue Shield of Rhode Island · Effective Oct 1, 2026High impact
SNF HHA PT Coding
BCBSRI is implementing a claims processing edit effective October 1, 2026, requiring that all therapy service claims submitted with revenue codes 042X, 043X, or 044X must include the appropriate therapy modifier (GP for physical therapy, GO for occupational therapy, GN for speech-language pathology) appended to the CPT code. Claims missing the required modifier or with an incorrect modifier will be denied.
Blue Cross Blue Shield of Rhode Island · Effective Sep 1, 2026High impact
Telemedicine modifier – Claims edit effective September 1, 2026
Effective September 1, 2026, Blue Cross Blue Shield Rhode Island will implement a system-level claims edit that denies any claims submitted with telemedicine modifiers (93, 95, FQ, or GT) unless paired with place of service code 02 or 10. Practices must immediately audit billing workflows to ensure telemedicine modifiers are only used when the appropriate telemedicine place of service is documented to avoid claim denials.
Blue Cross Blue Shield of Rhode Island · Effective Sep 1, 2026High impact
BlueCHiP for Medicare national and local coverage determinations policy
BlueCHiP for Medicare must now follow CMS national coverage determinations (NCDs) and local coverage determinations (LCDs) exclusively. Many BCBSRI policies previously applicable to both commercial and Medicare products are now commercial-only. Billing teams must reference BlueCHiP for Medicare's NCD/LCD policies rather than BCBSRI commercial policies for all Medicare Advantage claims.
Blue Cross Blue Shield of Rhode Island · Effective Sep 1, 2026High impact
New policy
BCBS Rhode Island has issued a new policy on Joint Replacement procedures, effective September 1, 2026. The full policy text is available in the Provider section of BCBSRI.com under Medical Policy. Billing teams must review the complete policy document to identify specific coverage criteria, prior authorization requirements, and billing code updates for shoulder and other joint replacement procedures.
Blue Cross Blue Shield of Rhode Island · Effective Sep 1, 2026High impact
Osteoporosis Management in Women (OMW): Timely Follow-Up After a Fracture
This is a new Medicare Advantage HEDIS quality measure (OMW) effective September 1, 2026, requiring women ages 67-85 with qualifying fractures to receive a bone mineral density (BMD) test or osteoporosis medication within 180 days post-fracture. Billing teams must ensure accurate coding of BMD tests and osteoporosis treatments (including injectables like denosumab, abaloparatide, teriparatide, romosozumab, and zoledronic acid) to capture completed follow-ups and avoid performance gaps.
Blue Cross Blue Shield of Rhode Island · Effective Sep 1, 2026High impact
Telemedicine Modifier - Claims Edit Effective September 1, 2026
Effective September 1, 2026, Blue Cross Blue Shield Rhode Island will implement a system edit that denies all claims submitted with telemedicine modifiers (93, 95, FQ, GT) if billed with any place of service code other than 02 (telehealth) or 10 (off-campus outpatient). Billing teams must ensure telemedicine modifiers are used exclusively with appropriate telehealth place of service codes to avoid automatic claim denials.
Blue Cross Blue Shield of Rhode Island · Effective Sep 1, 2026High impact
Payment policy updates
Effective September 1, 2026, claims submitted with telemedicine modifiers (93, 95, FQ, or GT) combined with in-office place of service codes (anything other than 02 or 10) will be automatically denied. Billing teams must ensure telemedicine modifiers are only used when place of service is coded as 02 (telehealth) or 10 (off-campus outpatient).
Blue Cross Blue Shield of Rhode Island · Effective Sep 1, 2026High impact
Telemedicine Modifier - Claims Edit Effective 9/1/26
Effective September 1, 2026, BCBS Rhode Island will implement a system edit to deny claims that combine telemedicine modifiers (93, 95, FQ, or GT) with place of service codes other than 02 (telehealth) or 10 (off-campus outpatient). Billing teams must ensure telemedicine modifiers are only used with appropriate telemedicine place of service codes to avoid claim denials.
Blue Cross Blue Shield of Rhode Island · Effective Sep 1, 2026High impact
Medical policy updates
Effective September 1, 2026, this comprehensive medical policy update introduces new prior authorization requirements for 29 spinal procedure CPT codes, three additional CPT codes (33285, 93228, 93229), and multiple genetic/biomarker testing codes across Medicare Advantage and/or commercial plans. Additionally, new ICD-10 diagnosis codes for Parkinson Disease chelation therapy, revised medical necessity criteria for multiple procedures, and significant reorganization of biomarker testing criteria into a centralized mandate policy will require billing system updates and provider notification.
Blue Cross Blue Shield of Rhode Island · Effective Sep 1, 2026High impact
Telemedicine Modifier - Claims Edit Effective 9/1/26
Effective September 1, 2026, claims with telemedicine modifiers (93, 95, FQ, or GT) must use place of service codes 02 or 10 only. Claims mixing telemedicine modifiers with in-office place of service codes will be automatically denied.
Blue Cross Blue Shield of Rhode Island · Effective Aug 15, 2026High impact
New Payment Policy: Device Intensive Procedure Edit
Starting August 15, 2026, outpatient facility claims for device intensive procedures must include a corresponding device procedure code on the same claim for the same date of service, or the claim will be denied. This policy only applies to facility claims (UB-04 forms, bill types 13X or 76X) and does not affect physician office billing.
Blue Cross Blue Shield of Rhode Island · Effective Aug 1, 2026High impact
BlueCHiP for Medicare national and local coverage determinations policy
BlueCHiP for Medicare will now strictly follow CMS National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs) rather than applying independent policy determinations. Many existing BCBSRI policies are now commercial-only, and providers must reference BlueCHiP for Medicare's NCD and LCD policies separately. This is a foundational policy shift effective August 1, 2026.
Blue Cross Blue Shield of Rhode Island · Effective Jul 13, 2026High impact
eviCore portal change
Effective July 13, 2026, eviCore will no longer accept authorization submissions through their portal for fully funded commercial members. This supersedes the October 1, 2025 removal of authorization requirements for PCP-ordered services for these members. Billing teams must stop attempting to enter authorizations in the eviCore portal for fully funded commercial plans.
Blue Cross Blue Shield of Rhode Island · Effective Jul 13, 2026High impact
eviCore Portal Update - effective 7/13
Effective July 13, 2026, eviCore will no longer accept authorization submissions through their portal for fully funded Commercial members. This supersedes the October 1, 2025 policy that removed authorization requirements for PCP-ordered services on fully funded Commercial plans. Billing teams must stop submitting authorizations to eviCore for these members and update internal workflows accordingly.
Blue Cross Blue Shield of Rhode Island · Effective Jul 1, 2026High impact
Payment Policy Updates
This policy contains three updates: (1) Telemedicine modifier claims (93, 95, FQ, GT) will be denied if billed with place of service codes other than 02 or 10, effective 9/1/26; (2) Thirteen new codes (A9574, C8014, G0574-G0678) are added as non-reimbursable for Commercial and Medicare Advantage plans effective 7/1/26; (3) Three COVID-19 treatment codes (M0231, M0232, Q0234) are added as covered and separately reimbursed effective 7/1/26.
Blue Cross Blue Shield of Rhode Island · Effective Jul 1, 2026High impact
Tips and documentation standards for interactive complexity and psychotherapy with E/M services
This policy clarifies correct documentation and billing standards for interactive complexity add-on code +90785 and psychotherapy codes when billed with E/M services. Key changes emphasize that +90785 applies only to documented interactional barriers requiring active management (not emotional difficulty), psychotherapy requires minimum 16 minutes of face-to-face therapeutic work with specific clinical documentation, and E/M and psychotherapy time must be separately tracked and documented to avoid compliance violations.
Blue Cross Blue Shield of Rhode Island · Effective Jul 1, 2026High impact
Requirement to refer members to in-network providers
BCBSRI now requires all contracted providers to refer members exclusively to in-network providers for all services including durable medical equipment, radiology, behavioral health, and laboratory/pathology services. The policy specifically identifies four laboratories (Accu Reference Lab, Quest Diagnostics, Total Toxicology, U.S. Lab and Radiology, Inc.) that are NOT in the BCBSRI network and must be avoided. Providers must verify in-network status using the BCBSRI Find a Doctor tool before establishing referral relationships.
Blue Cross Blue Shield of Rhode Island · Effective Jul 1, 2026High impact
Medicaid coverage of Medicare cost sharing
BCBS Rhode Island clarifies that Medicaid must cover Medicare cost sharing (copays and coinsurance) for DSNP members on specific services including PCP visits (excluding annual physicals), X-ray-related medical services, specialist visits, and Part B DME supplies. Providers who are not approved Medicaid providers cannot bill members for these cost-sharing amounts and must submit claims to Medicaid instead.
Blue Cross Blue Shield of Rhode Island · Effective Jul 1, 2026High impact
Medicare Advantage claims for out-of-network payments
BCBSRI clarifies that Medicare Advantage out-of-network providers must be paid at FFS Medicare rates and must accept this payment in full without balance billing members. Providers are required to bill BCBSRI for Medicare members and cannot use their participating provider contracts to negotiate higher rates for MA out-of-area claims.
Blue Cross Blue Shield of Rhode Island · Effective Jul 1, 2026High impact
Medical policy updates
Effective July 1, 2026, multiple policy changes include removing prior authorization for chronic liver disease testing (CPT 0344U), adding prior authorization requirements for tibial nerve stimulation, changing orthognathic surgery codes to use general prior authorization criteria instead of specialty-specific criteria, and updating various other testing and procedure requirements across Medicare Advantage and commercial plans.
Blue Cross Blue Shield of Rhode Island · Effective Jul 1, 2026High impact
Additional CPT® Code Changes
Blue Cross Blue Shield of Rhode Island updated CPT code coverage and payment rules for July 2026, affecting dozens of new codes with varying coverage levels including covered services, medical review requirements, and non-covered services depending on plan type. The changes include new laboratory codes (0636U-0659U), vaccine codes (90616, 90639), and Category T codes with different rules for Medicare Advantage vs Commercial products.
Blue Cross Blue Shield of Rhode Island · Effective Jul 1, 2026High impact
Additional HCPCS Level II Code Changes and Modifier Changes
Blue Cross Blue Shield of Rhode Island has updated coverage and payment rules for multiple HCPCS Level II codes effective July 1, 2026. The changes include new codes that will be covered and separately reimbursed, codes requiring medical review, and codes that will be covered but not separately reimbursed.
Blue Cross Blue Shield of Rhode Island · Effective Jun 1, 2026High impact
Medical policy updates
Multiple policy changes effective June 1, 2026, including coverage expansions for remote electrical neuromodulation for migraines and diabetic retinal screening, new prior authorization requirements for bariatric procedures, and updates to genetic testing criteria. Several CPT codes are being moved between policies or having their coverage status changed.
Blue Cross Blue Shield of Rhode Island · Effective Jun 1, 2026High impact
Guidelines for requesting point-of-service payment and maintaining patient credit card information
BCBSRI prohibits providers from collecting upfront payments from members with deductibles and requires automatic refunds when final adjudication shows overpayment, without waiting for member requests. Refunds must be processed timely and returned to the original payment source.
Blue Cross Blue Shield of Rhode Island · Effective Jun 1, 2026High impact
Medical policy updates
Multiple medical policy updates effective June through August 2026 affecting prior authorization requirements, coverage determinations, and billing procedures across various specialties. Key changes include removal of prior authorization for several CPT codes, coverage status changes for autism services and biomarker testing, and new medical criteria for vascular procedures.

Payer news

Network, contract and program news from the payers we track.

Blue Cross Blue Shield of Rhode Island · Nov 1, 2026Payer news
BCBSRI Behavioral Health Case Management program
BCBSRI has published information about its Behavioral Health Case Management program, which provides care coordination and support services through mental health and substance use professionals.
Blue Cross Blue Shield of Rhode Island · Oct 1, 2026Payer news
BCBSRI Behavioral Health Case Management program
BCBSRI has launched a new Behavioral Health Case Management program staffed by mental health and substance use professionals, effective October 1, 2026.
Blue Cross Blue Shield of Rhode Island · Sep 1, 2026Payer news
BCBSRI Behavioral Health Case Management program
BCBSRI has launched a new Behavioral Health Case Management program effective September 1, 2026, staffed by mental health and substance use professionals.
Blue Cross Blue Shield of Rhode Island · Sep 1, 2026Payer news
New virtual provider solution: TalkSpace
BCBSRI is launching TalkSpace, a new virtual behavioral health provider network offering telehealth mental health services (therapy, medication management, assessments) to all BCBSRI members nationally effective September 1, 2026.
Blue Cross Blue Shield of Rhode Island · Aug 1, 2026Payer news
BCBSRI Behavioral Health Case Management program
BCBSRI has launched a new Behavioral Health Case Management program staffed by mental health and substance use professionals, effective August 1, 2026.
Blue Cross Blue Shield of Rhode Island · Aug 1, 2026Payer news
New Virtual Provider Solution: Grow Therapy
BCBSRI is launching Grow Therapy, a new virtual behavioral health provider network offering telehealth therapy and medication management services to members nationally.

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Medical policy updates

Payment policy updates

Maternity - Obstetrical Services

PT/OT prior authorization to expand on January 1, 2027

Medical policy updates

January 2027 Summary of Changes - Pharmacy

Subject: CMS-0057 Electronic Prior Authorization – Provider Readiness and Onboarding

Network Updates

InterQual updates

CMS-0057 Electronic Prior Authorization – Provider Readiness and Onboarding

Medicare ID cards for 2027

Medicare ID Cards for 2027

Medical policy updates

BlueCHiP for Medicare national and local coverage determinations policy

Payment policy updates

Payment Policy Updates

Provider notice: Benefit coverage change

Anthem Dual Par Issue

Requirement to refer members to in-network providers

SNF Home Health Agency coding

Payment policy updates

Provider Notice: Benefit Coverage Change

SNF HHA PT Coding

Benefit Coverage Change for Medications

Medical policy updates

SNF HHA PT Coding

Telemedicine modifier – Claims edit effective September 1, 2026

BlueCHiP for Medicare national and local coverage determinations policy

New policy

Osteoporosis Management in Women (OMW): Timely Follow-Up After a Fracture

Telemedicine Modifier - Claims Edit Effective September 1, 2026

Payment policy updates

Telemedicine Modifier - Claims Edit Effective 9/1/26

Medical policy updates

Telemedicine Modifier - Claims Edit Effective 9/1/26

New Payment Policy: Device Intensive Procedure Edit

BlueCHiP for Medicare national and local coverage determinations policy

eviCore portal change

eviCore Portal Update - effective 7/13

Payment Policy Updates

Tips and documentation standards for interactive complexity and psychotherapy with E/M services

Requirement to refer members to in-network providers

Medicaid coverage of Medicare cost sharing

Medicare Advantage claims for out-of-network payments

Medical policy updates

Additional CPT® Code Changes

Additional HCPCS Level II Code Changes and Modifier Changes

Medical policy updates

Guidelines for requesting point-of-service payment and maintaining patient credit card information

Medical policy updates

Payer news

BCBSRI Behavioral Health Case Management program ↗

BCBSRI Behavioral Health Case Management program ↗

BCBSRI Behavioral Health Case Management program ↗

New virtual provider solution: TalkSpace ↗

BCBSRI Behavioral Health Case Management program ↗

New Virtual Provider Solution: Grow Therapy ↗

BCBSRI Behavioral Health Case Management program

BCBSRI Behavioral Health Case Management program

BCBSRI Behavioral Health Case Management program

New virtual provider solution: TalkSpace

BCBSRI Behavioral Health Case Management program

New Virtual Provider Solution: Grow Therapy