Medicare AdvantageAdministrativeMedium impact
Medicare Advantage claims for out-of-network payments
Blue Cross Blue Shield of Rhode Island·RI·Provider Update
Effective date
Jan 1, 2026
We identified it
Jun 19, 2026
Summary
BCBSRI updated their Medicare Advantage out-of-network payment policy effective January 1, 2026. Providers must bill BCBSRI for out-of-area Medicare Advantage members at FFS Medicare rates and cannot balance bill patients.
Action Required
By January 1, 2026: Billing team must ensure all out-of-area Medicare Advantage claims are submitted to BCBSRI instead of the member's home plan. Accept BCBSRI payment as payment in full at FFS Medicare rates. Update billing procedures to prohibit balance billing for these members. Review MA Payment Guide for Out-of-Network Payments for detailed requirements.