BCBSRI remains committed to improving the health of our members by providing access to high quality, cost-effective healthcare and championing health equity. 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 again for commercial and Medicare Advantage products for dates of service occurring on or after 1 de novembro, 2022.  

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 updated 2022 standard fee schedule is based on the 2021 RIMFS for the vast majority of codes/services.

Evaluation & Management services

Please be advised that BCBSRI is updating its allowable amounts/rates for common evaluation and management (E&M) services for 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 rates for E&M services.

Other updates

BCBSRI has also made other rate adjustments in its fee schedule, both upward and downward, generally following Medicare changes and to better align rates for similar services/code ranges. Please review the codes/services that your office frequently provides 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 bcbsri.com by 1 de setembro, 2022. To access your fee schedule, you can log on to our secure provider portal and click “fee schedules" on the left-hand navigation. Only system administrator accounts can access fee schedules.

If you do not have system administrator account access, please follow the below steps to obtain access:

1. On the bcbsri.com home page, go to log in and select “register now".
2. Select Provider, review terms and conditions and select the participating provider link
3. Enter your NPI, TAX ID, DOB, and email address and press GO.
4. Create your username and password to log in and view your 2022 standard fee schedule.

BCBSRI’s ongoing investments in Rhode Island’s provider community

BCBSRI continues to invest in our systems of care (SOC) or accountable care organizations by establishing rate differentials for PCP’s who are part of SOC’s.  In addition, BCBSRI continues to invest and expand in programs that support the triple aim of better health for Rhode Islanders, a simpler patient experience, and lower costs.

Examples of our efforts include:

• Our PCP Quality Incentive Program awards PCPs with quality-based incentives that recognize the quality of the care they deliver. The program 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 patient-centered medical home model and supports the further development of SOC through value-based contracts.
• We remain committed to moving toward healthcare payment 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.