Medicare AdvantageAdministrativeHigh impact
D-SNP member cost share reminder
Blue Cross Blue Shield of Rhode Island·RI·Provider Update
We identified it
Jun 19, 2026
Summary
D-SNP (Dual Special Needs Plan) members have cost-sharing requirements for certain services including PCP visits, X-rays, specialist visits, and Part B DME supplies. All member cost shares must be billed to Medicaid, and providers who are not approved Medicaid providers cannot bill the member directly for copays or coinsurance.
Action Required
Immediately: Billing team must ensure all D-SNP member cost shares (copays/coinsurance) are billed to Medicaid for PCP visits (excluding annual physicals), X-rays, specialist visits, and Part B DME supplies. Verify Medicaid provider status - if not an approved Medicaid provider, do not bill the member for any cost-sharing amounts. Update billing workflows to route D-SNP cost shares to Medicaid as secondary payer.