Medicare AdvantageReimbursementMedium impact
Medicare Advantage claims for out-of-network payments
Blue Cross Blue Shield of Rhode Island·RI·Provider Update
Effective date
Jan 1, 2025
We identified it
Jun 19, 2026
Summary
BCBSRI Medicare Advantage plans will now pay out-of-network providers at Fee-for-Service Medicare rates when treating members from other MA plans. Providers must bill BCBSRI as they would bill Medicare, accept payment as payment in full, and cannot balance bill the member.
Action Required
Immediately: When treating Medicare Advantage members from other plans in BCBSRI service area, billing team must process claims using standard Medicare billing procedures and accept BCBSRI payment as payment in full. Update billing staff training to ensure no balance billing occurs for these out-of-network MA claims. Review MA Payment Guide for Out-of-Network Payments linked in policy.