Medicare AdvantageReimbursementMedium impact
Medicare Advantage claims for out-of-network payments
Blue Cross Blue Shield of Rhode Island·RI·Provider Update
Effective date
Feb 1, 2019
We identified it
Jun 20, 2026
Summary
BCBSRI clarifies that Medicare Advantage out-of-network providers must be paid at Medicare Fee-for-Service rates and cannot balance bill members. Providers must bill BCBSRI exactly as they would bill Medicare and accept payment as payment in full.
Action Required
Immediately: Billing team must ensure all BCBSRI Medicare Advantage out-of-network claims are billed using Medicare Fee-for-Service billing procedures and rates. Update billing protocols to accept BCBSRI payment as payment in full without balance billing members. Train staff on proper Medicare billing format for these claims.