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Access to care standards for all providers
Blue Cross Blue Shield of Rhode Island·RI · Family Medicine, Internal Medicine, Pediatrics +1 more·Provider Update
Effective date
Jan 1, 2023
We identified it
Jun 19, 2026
Summary
BCBS Rhode Island has established access to care standards defining which providers can serve as Primary Care Providers (PCPs) and their responsibilities for coordinating member healthcare. This policy clarifies that PCPs must be board-certified physicians in internal medicine, pediatrics, or family medicine, or appropriately licensed nurse practitioners, physician assistants, and some Ob/Gyns providing primary care services.
Action Required
No immediate billing system changes required. Billing team should verify that all PCPs in their network meet the defined qualifications (board-certified MDs/DOs in internal medicine, pediatrics, or family medicine, or licensed NPs/PAs/Ob-Gyns providing primary care) to ensure proper claim processing and member coordination.