Provider Remittance Advices
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1 sep, 2019

End State Renal Disease (ESRD) 2728 form

As you know, CMS requires completion of a 2728 form for all newly diagnosed ESRD patients. The form serves two main purposes:

1.           Provides medical evidence of an end-stage renal condition for Medicare entitlement, and;

2.           Registers a patient in a national renal registry.

By CMS rules, the form must be submitted by the provider that provided the initial diagnosis. We are asking that you submit the completed form for all newly diagnosed members to BCBSRI when you submit the form to Medicare. You can email or fax us a copy of the form to BCBSRI at:

Email: 2728Forms@bcbsri.org

Fax: 401-459-1708

If you have any additional questions regarding this process, please email 2727Forms@bcbsri.org.

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