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.
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.