CommercialReimbursementMedium impact
Payment Policy Updates
Blue Cross Blue Shield of Rhode Island·RI·Facility
Effective date
Nov 1, 2024
We identified it
Jun 19, 2026
Summary
BCBS Rhode Island updated payment policies for local in-network facilities reimbursed as DRG, excluding mental health, maternity, and rehabilitation. Transfer logic now only applies to specific discharge codes 02, 05, and 65 for transfers to short-term hospitals, cancer centers/children's hospitals, and long-term care hospitals.
Action Required
Immediately: Billing team must update DRG transfer logic in billing system to only apply to discharge status codes 02, 05, and 65. Verify that mental health, maternity, and rehabilitation cases are excluded from these new transfer guidelines. Update billing workflows to properly code transfers only to short-term general hospitals (02), designated cancer centers/children's hospitals (05), and long-term care hospitals (65).