Medicare AdvantageBilling CodesHigh impact
Medicaid coverage of Medicare cost sharing
Blue Cross Blue Shield of Rhode Island·RI·Provider Update
Effective date
Jul 1, 2026
We identified it
Jul 1, 2026
Summary
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.
Action Required
By July 1, 2026: Billing team must implement the following changes for all DSNP member claims: (1) Update billing system to automatically route cost-sharing charges (copays/coinsurance) for PCP visits, specialist visits, X-ray-related services, and Part B DME supplies to Medicaid instead of the member; (2) Verify practice's Medicaid provider status—if not approved, immediately stop all direct member billing for these cost-sharing amounts and establish Medicaid claim submission process; (3) Train front desk and billing staff to inform DSNP members that they should not receive bills for copays or coinsurance on these covered services; (4) Update claim submission workflows to ensure cost-sharing amounts are billed to Medicaid first; (5) Reference the Medicare Cost Sharing by Medicaid Q&A and Scenarios documents (linked in policy) for denial reason codes and specific billing scenarios. Failure to comply will result in compliance violations and potential member billing issues.