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 requested to submit medical records and billing documentation to support billed charges before claims are processed and paid.
Action Required
Immediately: Ensure all medical records contain complete documentation supporting diagnosis and services billed. Prepare to respond promptly to BCBSRI requests for medical records and billing documents during prepayment reviews. Review documentation practices to ensure they support charges as billed and demonstrate medical necessity.