Medicare AdvantageReimbursementMedium impact
Medicare Advantage claims for out-of-network payments
Blue Cross Blue Shield of Rhode Island·RI·Provider Update
Effective date
Jan 1, 2019
We identified it
Jun 20, 2026
Summary
BCBSRI Medicare Advantage plans must pay out-of-network providers at least the same rates as Fee-for-Service Medicare when treating members from other MA plans. Providers must bill BCBSRI as they would bill Medicare, accept payment in full, and cannot balance bill the member.
Action Required
Immediately: When treating Medicare Advantage members from other plans outside your network, bill BCBSRI using the same process as traditional Medicare billing. Accept BCBSRI payment as payment in full and do not balance bill the member. Billing team must ensure claims are submitted to BCBSRI, not the member's original MA plan, when treating out-of-area MA members.