Medicare AdvantageBilling CodesHigh impact
Medicaid Coverage of Medicare Cost Sharing
Blue Cross Blue Shield of Rhode Island·RI·Provider Update
Effective date
May 1, 2025
We identified it
Jun 19, 2026
Summary
D-SNP (Dual-Eligible Special Needs Plan) members have 20% coinsurance on certain services that must be billed to Medicaid, not the member. Providers who are not approved Medicaid providers cannot bill members for these cost-sharing amounts.
Action Required
By May 1, 2025: Billing team must identify all D-SNP members and update billing workflows to send copay/coinsurance amounts to Medicaid instead of billing the member. Verify Medicaid provider status - if not an approved Medicaid provider, write off any D-SNP member cost-sharing amounts rather than billing the member. Update billing system to flag denial reason code MA1 for proper handling.