CommercialAdministrativeMedium impact
Optum denial reminders
Blue Cross Blue Shield of Rhode Island·RI·Provider Update
Effective date
Oct 1, 2025
We identified it
Jun 19, 2026
Summary
When Optum denies a claim (indicated by lowercase 'b' in denial code), all medical records and appeals must be sent directly to Optum, not BCBSRI. There is only one level of appeal available through Optum.
Action Required
Immediately: Billing team must identify all Optum denials by looking for lowercase 'b' in denial codes. Send all appeals and medical records directly to Optum using methods specified on Optum denial letters, not to BCBSRI. Note there is only one appeal level available. If Optum incorrectly advises you can appeal to BCBSRI after denial, report this to ProviderRelations@bcbsri.org.