Medicare AdvantageBilling CodesHigh impact
Hospital Based Clinics
Blue Cross Blue Shield of Rhode Island·RI · Family Medicine, Internal Medicine, General Practice +1 more·Physician / Facility
Effective date
Aug 1, 2019
We identified it
Jun 20, 2026
Summary
Effective 8/1/19, BCBSRI requires Primary Care Physicians and Dual Providers (including midlevel practitioners) at hospital-based clinics to bill services on CMS-1500 forms using their Type 1 NPI number with appropriate E&M codes. This ensures subscriber benefits are applied correctly for patient expectations.
Action Required
Immediately: Billing team must ensure all Primary Care Physicians and Dual Providers (including midlevel practitioners) at hospital-based clinics bill services on CMS-1500 forms using their Type 1 NPI number and appropriate Evaluation and Management codes (99000 series codes, G0438, G0439 for Medicare Advantage wellness visits). Update billing system settings and train staff on proper form submission to ensure subscriber benefits are applied correctly.