Fee Schedule Changes effective 9/1/21
BCBSRI is committed to improving the health of our members by providing access to high quality, cost-effective healthcare. As part of this commitment, BCBSRI reviews its fee schedules on an annual basis and makes updates as needed.
Update to standard fee schedules
BCBSRI is updating its standard fee schedule for Commercial and Medicare Advantage products for dates of service occurring on or after 1 de septiembre de 2021.
As in the past, BCBSRI uses the Rhode Island Medicare Fee Schedule (RIMFS) and its resource-based relative value scale (RBRVS) pricing methodology, as the basis for development of our fee schedule. More specifically, BCBSRI’s 2021 fee schedule is based on the 2020 RIMFS for the vast majority of codes/services.
- Evaluation & Management services
Please be advised that BCBSRI is updating its reimbursement for evaluation and management (E&M) services for all primary care providers (PCP), as well as specialist providers. As a result of this update, if you are a PCP or a specialist provider, you will see a net increase in your reimbursement for E&M services.
- Other updates
BCBSRI has also made other rate adjustments in its fee schedule, both upward and downward, following Medicare changes and to better align reimbursement for similar services/code ranges. Please review the codes/services that you frequently provide to identify the specific changes for your practice.
How to view updated fee schedules
An Excel file containing our updated fee schedules will be available on the Provider Portal of bcbsri.com by 1 de julio de 2021. To access your fee schedule, please log on to our secure Provider Portal and click “fee schedules" on the left-hand navigation. Please note, only system administrator accounts can access fee schedules.
If you do not have account access to the Provider Portal on bcbsri.com, please follow these steps to obtain access:
- Request a Provider Identification Number (PIN) by clicking on Website Registration of the log in section on the public provider website.
- Once you submit the information on the web you will be e-mailed your PIN.
BCBSRI’s ongoing investments in Rhode Island’s provider community
BCBSRI continues to invest in our Systems of Care by establishing rate differentials that support this goal. In addition, BCBSRI continues to invest and expand in programs that support the triple aim of better health for our state, a simpler patient experience, and lower costs.
Some examples of our efforts include:
- Our PCP Quality Incentive Program awards PCPs quality-based incentives that recognize the quality of the care they deliver. It also helps providers to identify and close gaps in care for their patients, which improves HEDIS scores and CMS five-star quality ratings.
- BCBSRI embraces the PCMH model, and supports the further development of Systems of Care, or accountable care organizations, through value-based contracts.
- We remain committed to moving toward reimbursement models that embrace quality, value, and efficiency, e.g. primary care and global capitation models, while following the affordability standards and alternative payment methodologies mandated by the Rhode Island Office of the Health Insurance Commissioner.
BCBSRI network participation
In compliance with Rhode Island law, if you wish to end your participation with BCBSRI as a result of the updated fee schedules, you may notify BCBSRI of your intent to terminate your Participating Physician/Provider Agreement within sixty (60) days of receipt of this notification. Any termination pursuant to Section IV.B of your Participating Physician/Provider Agreement shall be effective fifteen (15) calendar days from the mailing of the notice of termination by the Physician/Provider. The notice shall be sent by certified mail, return receipt requested, postage prepaid. We recommend that this notice be sent Attn: Provider Relations.
If you have any questions about changes to our standard fee schedule, please contact Provider Relations at 1-844-707-5627 or email ProviderRelations@bcbsri.org.