Medicare AdvantageBilling CodesHigh impact
Medicaid coverage of Medicare cost sharing
Blue Cross Blue Shield of Rhode Island·RI·Provider Update
Effective date
Jan 1, 2026
We identified it
Jun 19, 2026
Summary
Effective January 1, 2026, D-SNP (Dual Special Needs Plan) members will have 20% coinsurance on PCP visits (excluding annual physicals), X-rays, specialist visits, and Part B DME supplies. Providers must bill any D-SNP copays or coinsurance to Medicaid, and cannot bill the member directly if they are not an approved Medicaid provider.
Action Required
By January 1, 2026: Billing team must update workflows to automatically bill D-SNP member coinsurance to Medicaid as secondary payer. Update billing system to flag D-SNP members and ensure 20% coinsurance is not billed to patient for PCP visits (excluding annual physicals), X-rays, specialist visits, and Part B DME supplies. Verify Medicaid provider enrollment status - if not enrolled, claims with coinsurance cannot be billed to members and may result in write-offs.