Provider Remittance Advices
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1 mar, 2020

Cross-border notification reminder

If you have a BCBSRI member with an NEHP or State of Rhode Island anchor plan, a cross-border notification may be required depending on where their PCP and specialist are located. Please refer to this chart and scenarios to assist you.

If…
With a….
Going to see a….
Then….
Member has a RI NEHP plan
RI PCP
a RI specialist
Obtain referral through health trio if specialty requires
Member has RI NEHP plan
RI PCP
a specialist outside of RI within the New England region
Follow the cross border notification workflow on bcbsri.com
Member has a RI NEHP plan
New England Region PCP
a specialist within the New England Health Plan region
Follow the New England cross border notification workflow through the PCP’s local plan
Member has a State of RI plan
RI PCP
a RI specialist
Obtain referral through health trio if specialty requires
Member has a State of RI plan
RI PCP
a specialist outside of RI within the New England region
Follow the cross border notification workflow on bcbsri.com
Member has a State of RI plan
New England Region PCP
a specialist within the New England Health Plan region
Follow the New England cross border notification workflow through the PCP’s local plan

Scenarios:

  • A Rhode Island NEHP member has a Rhode Island PCP who wants them to see a cardiologist in Rhode Island. The PCP will need to see if the specialty requires a referral. If so, the PCP will have to enter a referral into Health Trio.
  • A Rhode Island NEHP member has a Rhode Island PCP who wants them to see a cardiologist in Massachusetts. The PCP will need to follow the cross-border notification workflow and enter a cross-border notification on bcbsri.com.
  • A Rhode Island NEHP member has a Massachusetts PCP who wants to see a cardiologist in Massachusetts. The Massachusetts PCP will need to follow the New England cross-border notification workflow through the PCP’s local plan.
  • A State of Rhode Island member has a Rhode Island PCP who wants them to see a cardiologist in Rhode Island. The PCP will need to see if the specialty requires a referral. If so, the PCP will have to enter a referral into Health Trio.
  • A State of Rhode Island member has a Rhode Island PCP who wants to go see a cardiologist in Massachusetts. The PCP will need to follow the cross-border notification workflow and enter a cross border notification on bcbsri.com.
  • A State of Rhode Island member has a Massachusetts PCP who wants to see a cardiologist in Massachusetts. The Mass PCP will need to follow the New England cross border notification workflow through the PCP’s local plan.
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