Provider Enrollment

Provider Participation

To participate in the RI Medicaid, providers must be located and performing services in Rhode Island or in a border community PDF. Consideration will be given to out-of-state providers if the covered service is not available in Rhode Island, the recipient is currently residing in another state or if the covered service was performed as an emergency service while the recipient was traveling through another state.

Instructions for Enrollment as a Medicaid Provider

Provider Enrollment in RI Medicaid is Changing!

On August 3, 2015, provider enrollment for the RI Medicaid Program will be completed electronically through the Enrollment Portal, in the Healthcare Portal.  Paper applications will no longer be accepted except for attending physicians being added to an existing group.

It is important to note the following:

  • Paper applications received beginning Friday, July 17th will not be processed and will be returned to the provider.
  • Providers will need to wait for August 3 to enroll through the Enrollment Portal of the Healthcare Portal.  The Enrollment Portal will not be available before August 3.
  • Instructions for competing the electronic application will be accessible through the Healthcare Portal.
  • Attending physicians being added to a group will continue to submit a paper application.

If you have any questions, please contact the Customer Service Help Desk at (401) 784-8100.

To become a Medicaid Provider, please select from the links below. Please be sure to complete all information on the application prior to submitting.

For New Providers

Medicaid Provider Application - Individuals  
Medicaid Provider Application - Groups  

Adding a Provider, RIte Share, and LEA Providers

New Provider Joining an Existing Group
RIteShare Providers 
Local Education Agency (LEA) Providers

Enrolling as a Trading Partner

Once you are enrolled in RI Medicaid you must apply for a Trading Partner ID to access eligibility, claim status and remittance advice.  Applicants may access the electronic enrollment process by visiting the RI Healthcare Portal.

All existing Trading Partners are required to register in the Healthcare Portal.  Please refer to the current issue of the Provider Update.  Additional resources are found on the Healthcare Portal page.

Additional Forms

Authorization for Direct Deposit (Mandatory)
Provider Change of Information Form PDF
Home Care Transportation Certification   (Mandatory for Home Care Agencies)

Send all forms to:

HP Enterprise Services/Provider Enrollment
P.O. Box 2010
Warwick, Rhode Island 02887-2010

Need help with the application process?   Please call: Dianne Folco (401) 784-3801

LINKS

Are you using Electronic Billing?
Billing software is available at no cost to RI Medicaid Providers. Download a copy of our proprietary software Provider Electronic Solutions (PES) Software. We provide training and support to get you started.

Want to check your Claims or Prior Authorization status online?
Please visit the Healthcare Portal page for more information or to apply for a Trading Partner number.

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