CommercialAdministrativeMedium impact
Methadone reimbursement guidelines for BCBSRI commercial members with Medicare as primary coverage
Blue Cross Blue Shield of Rhode Island·RI · Psychiatry, Pain Management·Behavioral Health
Effective date
Sep 1, 2020
We identified it
Jun 19, 2026
Summary
For BCBSRI commercial members who have Medicare as their primary insurance, providers must now bill Medicare first for methadone maintenance services instead of billing BCBSRI directly. Claims submitted to BCBSRI for these dual-coverage members will be denied with instruction to file to Medicare first.
Action Required
Immediately: Billing team must verify insurance coverage for all methadone maintenance patients and identify BCBSRI commercial members with Medicare as primary. Update billing workflows to submit claims to Medicare first for these dual-coverage members. Claims incorrectly submitted to BCBSRI will be denied and returned.