CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

Provider Contract Transparency

This document governs BCBSRI's policy on treating provider contract terms as confidential and the circumstances under which disclosure is permitted; it affects BCBSRI and contracted providers for BlueCHiP for Medicare and Commercial Products.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyProvider Contract Transparency

Policy CodePolicy N/A

Change TypeNo material change

Effective DateApr 16, 2013

Next Review DateN/A

Key ActionProviders must treat contract terms as confidential and may not disclose them except to attorneys, accountants, consultants, or when required by law or BCBSRI needs.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

2013-04-16effective date

2017-03-21policy last updated

BlueCHiP & Commercialproducts referenced

Confidentiality requireddisclosure stance

Coverage Criteria

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

ALL of the following

Medical criteria: Not applicable
Prior authorization: Not applicable
Coverage: Not applicable
Coding: Not applicable

Statement summary

No medical necessity criteria are defined in this policy.
No prior authorization requirements are defined in this policy.
No coverage determinations are established in this policy.
No coding criteria are established in this policy.

Confidentiality and Permitted Disclosures — Provider Actions

Documentation Required

Treat contract terms as confidential; permitted and required disclosures

BCBSRI and its Providers must treat the terms of their contracts as confidential and may not disclose contract terms to any other party except to attorneys, accountants, and consultants in the course of business, or when disclosure is required by state or federal law or to support BCBSRI’s business or regulatory needs (including transparency programs). Parties shall provide each other with reasonable notice where possible of disclosures required by law.

Permitted disclosures: attorneys, accountants, consultants in their course of business with BCBSRI or the Provider
Required disclosures: when state or federal law requires it or to support BCBSRI business/regulatory needs (including transparency programs)
A request by a state or federal agency is deemed a requirement of law
Parties shall provide reasonable notice of required disclosures where possible

Definitions

Confidential contract terms: key facts

DefinitionConfidential contract terms: terms of BCBSRI–provider contracts that shall not be disclosed to other parties except to attorneys, accountants, and consultants in the course of business, or when required by state or federal law or BCBSRI business/regulatory needs (including transparency programs).

Permitted disclosuresMay be disclosed to attorneys, accountants, and consultants in the course of business with BCBSRI or the provider.

Required disclosuresDisclosure is permitted when required by state or federal law or to support BCBSRI business or regulatory needs (including transparency programs); a request by a state or federal agency is deemed a legal requirement.

Notification expectationParties shall provide each other with reasonable notice where possible of disclosures required by state or federal law.

Products in scopeApplies to BlueCHiP for Medicare and Commercial Products.

Policy contextBCBSRI supports transparency and believes sharing cost and quality data is critical to improving the healthcare system and affordability; this policy governs confidentiality of contract terms within that context.