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1 feb, 2020

NEHP & State of Rhode Island Cross Border Notification Guide

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:

  • Rhode Island NEHP member has a RI PCP who wants to go 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.
  • Rhode Island NEHP member has a RI 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 via bcbsri.com
  • Rhode Island NEHP member has a Mass 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. 
  • State of RI member has a RI PCP who wants to go 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.
  • State of RI member has a RI 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 via bcbsri.com
  • State of RI member has a Mass 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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