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End State Renal Disease (ESRD) 2728 form

Blue Cross Blue Shield of Rhode Island·RI · Nephrology, Internal Medicine, Family Medicine·Physician / Facility
Effective date
Sep 1, 2019
We identified it
Jun 20, 2026
Days to comply

Summary

BCBSRI now requires providers to submit a copy of the CMS 2728 form (used for newly diagnosed ESRD patients) to BCBSRI when submitting to Medicare. This is an additional administrative step for End Stage Renal Disease diagnoses.

Action Required

Action needed
For all newly diagnosed ESRD patients: Submit completed 2728 form to both Medicare AND BCBSRI. Email forms to 2728Forms@bcbsri.org or fax to 401-459-1708. Update workflow to include this additional submission step for the diagnosing provider.