CommercialDocumentationHigh impact
Prepayment change effective July 2024
Blue Cross Blue Shield of Rhode Island·RI·Provider Update
Effective date
Jul 1, 2024
We identified it
Jun 19, 2026
Summary
BCBSRI implemented additional prepayment claim reviews using Optum's CPI tool effective July 2024. Providers may now be asked to submit medical records and billing documents to support charges before claims are processed and paid.
Action Required
Immediately: Ensure all medical records contain complete documentation supporting diagnosis and services/supplies billed. Billing team must be prepared to respond promptly when BCBSRI requests medical records and billing documents for prepayment review. Establish workflow to quickly gather and submit requested documentation when detailed instructions are received from BCBSRI.