01Already effective January 1, 2017: Providers must enter referrals for BlueCHiP Commercial, BlueCHiP for Medicare Advance and NEHP members in referral-based plans in the web-based referral tool.
02PCPs must select the practice location of the specialist being referred to so the specialist's claim pays correctly.
03Referrals can be backdated 30 days from the date entered in the tool and are good for six months once entered.
04For NEHP cross-border referrals to providers in other New England states, the traditional fax-based process continues.
05Already effective April 1, 2017: Get prior authorization before scheduling a subcutaneous implantable cardioverter-defibrillator insertion for Commercial members.
06The codes are listed in the Preauthorization via Web-Based Tool for Procedures policy.
07Submit peripheral subcutaneous field stimulation for chronic neuropathic pain with unlisted CPT 64999 and follow the unlisted process.
08Already effective July 1, 2016: Bill HCPCS S0285 to identify the pre-operative examination or consultation before a preventive colonoscopy for Commercial members.
09Already effective January 1, 2017: Providers who opt out of Medicare must file an affidavit with all Medicare Administrative Contractors that have jurisdiction over them within 10 days of entering into the first private contract with a Medicare beneficiary.
10For BCBSRI Commercial members with Medicare as primary coverage, file a paper claim directly with BCBSRI, which allows 20% of the current Rhode Island Medicare Fee Schedule.
11Mail it to Blue Cross & Blue Shield of Rhode Island, ATTN: Basic Claims, 500 Exchange Street, Providence, RI 02903, then collect the remaining balance from the Medicare beneficiary under the private contract.
12Practice information: Providers must give BCBSRI a 60-day notification of any provider or practice changes.
13Submit the BCBSRI Practitioner Change Form for updates.
14When the quarterly validation fax arrives, make needed updates, check the attestation box and fax it back, even if the information is accurate.
15Collaborative care: Email a detailed program description to behavioralhealth@bcbsri.org before billing collaborative care codes G0502, G05023 or G0504 for BlueCHiP for Medicare members.
16Providers can submit claims 60 days after program approval, and no retroactive payments will be made for services rendered.
17Collaborative care is not separately reimbursed for Commercial products.
18Institutional claims: File all inpatient institutional claims, and specific outpatient claims, with the admission date, time and diagnosis code on paper and electronic 837I transactions for bill types 12X, 22X, 32X, 34X, 81X and 82X.