Medicare AdvantageAdministrativeMedium impact
Medicare Advantage claims for out-of-network payments
Blue Cross Blue Shield of Rhode Island·RI·Provider Update
Effective date
Jul 1, 2025
We identified it
Jun 19, 2026
Summary
BCBSRI clarified that when providers see Medicare Advantage members from other plans, they must bill BCBSRI as if billing Medicare and accept payment as payment in full without balance billing the member. Providers are considered non-network but treated as Medicare participating providers with payment at FFS Medicare rates.
Action Required
By July 1, 2025: Billing team must update procedures for Medicare Advantage out-of-network claims to bill BCBSRI using the same process as Medicare billing. Train staff to accept BCBSRI payment as payment in full and ensure no balance billing occurs for out-of-area Medicare Advantage members. Review the MA Payment Guide for Out-of-Network Payments linked in the policy.