CommercialAdministrativeMedium impact
BCBSRI does not credential groups
Blue Cross Blue Shield of Rhode Island·RI·Physician / Behavioral Health
Effective date
Jul 1, 2024
We identified it
Jun 19, 2026
Summary
BCBSRI does not credential groups (except ancillary services) and only credentials individual providers within groups. When creating new groups, individual providers must complete credentialing applications or PCF forms to be tied to the new group, and all professional claims must include both the rendering provider's NPI and the Type 2 billing NPI.
Action Required
Immediately: Billing team must ensure all BCBSRI professional claims include both the rendering provider's individual NPI and the Type 2 billing NPI. Do not send group contracts to credentialing for individual professional providers. For new groups, ensure individual providers complete credentialing applications or PCF forms rather than group credentialing. Update billing system to verify proper NPI usage for BCBSRI claims.