Medicare AdvantageReimbursementMedium impact
Medicare Advantage claims for out-of-network payments
Blue Cross Blue Shield of Rhode Island·RI·Provider Update
Effective date
Jul 1, 2024
We identified it
Jun 19, 2026
Summary
BCBSRI Medicare Advantage plans now pay out-of-network providers at Medicare Fee-for-Service rates, not contracted rates. Providers must bill as they would Medicare and accept payment in full without balance billing the member.
Action Required
Immediately: Billing team must update procedures for BCBSRI Medicare Advantage out-of-network claims - bill using same format as Medicare Fee-for-Service, accept BCBSRI payment as payment in full, and do not balance bill members. Update billing system to flag these claims for special processing at Medicare rates rather than contracted rates.