All PlansCoverageMedium impact
New policies
Blue Cross Blue Shield of Rhode Island·RI · Cardiology, Orthopedics·Physician
Effective date
Aug 1, 2026
We identified it
Aug 1, 2026
Summary
Blue Cross Blue Shield Rhode Island has created two new medical policies effective August 1, 2026: one covering Closure Devices for Patent Foramen Ovale and Atrial Septal Defects, and another covering Facet Arthroplasty. The billing team must review the full policy text on BCBSRI.com to identify specific coverage criteria, billing codes, and prior authorization requirements for these procedures.
Action Required
By July 15, 2026: Billing team must access the full policy text for both new policies in the Provider section of BCBSRI.com under Medical Policy heading. Extract specific CPT/HCPCS codes, coverage criteria, and prior authorization requirements. Update billing system rules, encounter forms, and provider education materials accordingly. Communicate with cardiology and orthopedic providers about documentation and authorization requirements. Failure to implement proper authorization processes may result in claim denials effective August 1, 2026.