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.
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What to do
immediately · 2 steps
01Billing 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).
02Update billing system settings and train staff on proper form submission to ensure subscriber benefits are applied correctly.
Codes mentioned
G0438G0439
Original notice
Hospital Based Clinics
bcbsri.com · Always check the source before changing claims.
Related changes
See all Blue Cross Blue Shield of Rhode Island changes →November - December 2017MediumEffective Jan 1, 2018 · Provider UpdateInitial annual wellness examination for BlueCHiP for Medicare membersMediumEffective Oct 1, 2019 · Physician / FacilityHints for HEDIS® (and more)MediumEffective Jan 1, 2022 · PhysicianBrowse every Blue Cross Blue Shield of Rhode Island change in the policy list