CommercialAdministrativeHigh impact
Optum denial reminders
Blue Cross Blue Shield of Rhode Island·RI·Provider Update
Effective date
Nov 1, 2025
We identified it
Jun 19, 2026
Summary
For BCBS Rhode Island Optum denials marked with lowercase 'b', all medical records and appeals must be sent directly to Optum using their specified methods. There is only one level of appeal with Optum - if they say you can appeal to BCBSRI after denial, that information is incorrect.
Action Required
Immediately: Billing team must identify all BCBSRI claims denied with lowercase 'b' and send appeals/medical records directly to Optum using methods specified in their denial letters. Do not send secondary appeals to BCBSRI. If Optum staff provides incorrect appeal guidance, report the representative's information to ProviderRelations@bcbsri.org.