Medicare AdvantageReimbursementMedium impact
Medicare Advantage claims for out-of-network payments
Blue Cross Blue Shield of Rhode Island·RI·Provider Update
Effective date
Apr 1, 2024
We identified it
Jun 19, 2026
Summary
BCBSRI clarifies that Medicare Advantage out-of-network providers must be paid at Medicare Fee-for-Service rates and cannot balance bill members. Providers must bill BCBSRI as they would Medicare and accept payment as payment in full.
Action Required
Immediately: Billing team must ensure all BCBSRI Medicare Advantage out-of-network claims are billed using standard Medicare billing procedures. Accept BCBSRI payments as payment in full and do not balance bill members. Review current billing practices to ensure compliance with no-balance-billing requirement.