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 is implementing additional prepayment claim reviews effective July 2024 using Optum's Comprehensive Payment Integrity tool. Providers may be asked to submit medical records and billing documents to support charges before claims are processed and paid.
Action Required
By July 2024: All providers must be prepared to submit detailed medical records and billing documentation when requested by BCBSRI during prepayment reviews. Ensure all medical records contain complete documentation supporting diagnosis and services/supplies billed. Train billing team on new documentation submission process when detailed instructions are provided by BCBSRI. Claims may be adjusted or denied if documentation does not support services as billed.