Frequently Asked Questions

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Plans & Services

Typically, your renewal is on the anniversary date of your plan's initial effective date. For example, if your plan became effective on January 1, 2009, your renewal would be January 1, 2010.

Healthcare Fraud

Blue Cross prevents and identifies fraud by analyzing data and collaborating with outside organizations.

In addition to fraud reported by members or doctors, Blue Cross also prevents and identifies fraud by:

  • Analyzing data – We are implementing new, highly sophisticated fraud detection software to further analyze claims data and identify unusual billing patterns of medical procedures, and any patterns of potentially fraudulent behavior.
  • Collaborating with outside organizations – When appropriate, we work with the National Health Care Anti-Fraud Association, the Blue Cross and Blue Shield Association, law enforcement agencies, and public and private organizations to stop fraudulent activities.

You can protect yourself from fraud by safeguarding your member ID card and Social Security number, being wary of “free” services, and making sure you’ve received the medical services listed in your BCBSRI account.

BCBSRI will take actions to recover payments made as the result of fraudulent activity, put systems in place to stop the fraudulent behavior, and may also work with law enforcement when appropriate. As the result of fraud detection efforts, BCBSRI has realized over $10 million in savings over the past three years.

HIPAA Security & Privacy for Employers

The HIPAA Security Regulation defines specific standards and controls that must be in place to protect the confidentiality, integrity, and availability of electronic protected health information (ePHI). ePHI is information transmitted over the Internet and/or stored on a computer, CD, disk, magnetic tape, or other related means. This includes ePHI that is created, received, maintained, or transmitted. You can find the final Security Rule in the Federal Register of February 20, 2003.

Any covered entity (healthcare provider, healthcare plan and healthcare clearinghouse) that files claims or receives remittance advices electronically must comply with the HIPAA Security Regulation. Please consult your legal counsel to determine your obligations. 

Blue Cross & Blue Shield of Rhode Island (BCBSRI) insures that our business practices comply with the security regulations. Some of the activities completed include:

  • Appointment of an information security official and privacy official
  • Routine risk assessments
  • Creating and/or modifying existing security and privacy policies/procedures
  • Entering into business associate contracts with key vendors
  • Executing a security and privacy awareness training program for our workforce

Several reputable agencies and organizations have posted helpful information about HIPAA Security on their Web sites:

  • The Centers for Medicare and Medicaid Services (CMS), the enforcement agency for HIPAA Security, has a section devoted to security education materials.
  • The U. S. Government Printing Office Web site has a link to the Federal Register (February 20, 2003) containing the final Security Rule.
  • The Workgroup for Electronic Data Interchange (WEDI), has information and links to other HIPAA resources.

We hope this information will assist you in your efforts to comply with the HIPAA Security Rule. If you would like to discuss how this new law will affect the way you communicate with BCBSRI, please contact your account executive.


You may use any of the 60,000 participating pharmacies in our network. To change your prescription to a new pharmacy, you can:

1. Bring your prescription bottle(s) to the new participating pharmacy. The pharmacist will contact your previous pharmacy and arrange for your prescriptions to be transferred.
2. Request a new written prescription from your doctor, and bring it to the new pharmacy to be filled.

First log in to the secure site, then click on Pharmacy from your member page. (If you don’t already have a login account, click on “Create a New Account”.) You will have access to a variety of pharmacy tools and information.