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Provider News 


  • Member Id Conversion
    In September 2016, RI Medicaid converted member ID numbers, formerly 9 digit social security numbers , to a randomly generated 10 digit ID number.  New cards are being sent to beneficiaries in waves.  Providers should make note of the new ID number, as well as request that the beneficiary produce the new card when available.  There is currently a dual window for claims processing, during which either the 9 digit to the 10 digit ID is be accepted. 
    The dual processing for claims will end on April 30, 2018.
    Claims submitted with a From Date of Service after 4/30/2018 will only be accepted with the new 10 digit Medicaid ID.  If an adjustment to a previously paid claim needs to be submitted after 4/30/2018 for a claim with dates of service before 4/30/2018 then either the  9 digit or 10 digit MID will be accepted.  Providers may still enter the social security number in the Healthcare Portal when verifying eligibility.  When the eligibility response is returned, the new 10 digit MID will be listed for the beneficiary's ID.
  • Ordering, Prescribing and Referring Provider 
    - On January 1, 2018, the edits were turned on to deny claims if the OPR is required and the OPR is not enrolled with RI Medicaid.
    Effective October 1, 2015, Ordering, Prescribing and Referring providers must be enrolled in the RI Medicaid program to order, prescribe, or refer items or services for Medicaid beneficiaries.  For more information on the claim types impacted or claims processing information, please review the Frequently Asked Questions document.
  • May 16, 2017  Long Term Care Interim Payment Process 
    Interim Payment Letter  
    RI Communication Tool May 2017  
    NH Turnaround Document  
  • February 10, 2017  Long Term Care Business Process -  Click here to view letter to providers
  • Home Health Final Rule (2348-F) - CMS has released details of the Home Health Final Rule (2348-F), including Medicaid face-to-face requirements for home health services, policy changes, and clarifications related to home health and Durable Medical Equipment.  EOHHS will continue to inform and educate providers over the upcoming months.  Rhode Island expects to come into compliance by July 1, 2017.  For more information click the following links:     
      Medicaid Program: Face-to-Face Requirements for Home Health Services; Policy Changes and      Clarifications Related to Home Health- A Rule by the Centers for Medicare and Medicaid                  Services on 02/02/2016.   
      DME Items:  Face to Face Requirement Effective 7/1/2017   


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