CommercialReimbursementHigh impact
Payment policy updates
Blue Cross Blue Shield of Rhode Island·RI · Emergency Medicine·Physician / Facility
Effective date
Aug 1, 2024
We identified it
Jun 19, 2026
Summary
BCBSRI is implementing new review procedures for Emergency Department E/M coding levels (99281-99285) to ensure appropriate resource utilization and coding accuracy. Claims may be adjusted to lower E/M levels or denied if coding doesn't align with patient presentation, diagnostic services, and complications.
Action Required
Immediately: Emergency Department billing teams must review all ED E/M coding practices to ensure level 1-5 codes (99281-99285) accurately reflect patient presentation, diagnostic services performed, and complications. Update coding guidelines to align with CMS requirements for hospital resource utilization. Prepare appeal processes for any claims that may be downgraded, as BCBSRI will now actively review and potentially adjust or deny claims that don't meet appropriate E/M level criteria.