BCBSRI is not a PPO network sharing plan. We are not allowed to price based on our participating provider contract. When a provider in our service area sees a Medicare member from another plan, they are considered non-network. However, they are treated as a Medicare participating provider. The Centers for Medicare and Medicaid Services (CMS) requires Medicare Advantage (MA) plans to pay non-network providers at least the rates that they would be paid by FFS Medicare, as this is how we process all MA out-of-area claims. CMS publishes a document that indicates how an MA plan must pay out-of-network providers. BCBSRI pays each service based on how the provider is paid by FFS Medicare. As a provider, you are required to bill BCBSRI as if you are billing Medicare, and you must accept this payment as payment in full and must not balance bill the member. For more information pertaining to the MA Payment Guide for Out-of-Network Payments, please click here.