CommercialDocumentationHigh impact
Payment policy updates
Blue Cross Blue Shield of Rhode Island·RI · Emergency Medicine·Physician / Facility
Effective date
Jul 1, 2024
We identified it
Jun 19, 2026
Summary
BCBSRI implemented new payment policies effective July 1, 2024, including stricter review of Emergency Department E/M coding levels (99281-99285), enhanced prepayment claim reviews requiring documentation support, and coverage of new colorectal screening test Colosense Plus (0646U) as a preventive service.
Action Required
Immediately: Emergency Department facilities must ensure proper documentation supports E/M coding levels 1-5 (99281-99285) as claims may be downgraded or denied based on patient presenting problem, diagnostic services, and complications. Billing team must prepare to provide medical records and billing documents when requested for prepayment reviews using Optum's CPI tool. Update billing system to include new HCPCS code 0646U for Colosense Plus colorectal screening as covered preventive service for commercial and Medicare Advantage plans.