Attention Providers: Change Healthcare Update Change Healthcare (CHC) can resume submitting claims to RI Medicaid. This means if you are doing business with CHC, they can submit your claims to RI Medicaid and CHC can now resume downloading your 835/277unsolicited transactions.Please reach out to your clearing house representative with any questions you may have regarding the submissions. You can also reach out to riediservices@gainwelltechnologies.com.
Pharmacy Medical Coverage Policies Pharmacy Coverage Policy Prescription Requirements Rebate Agreement Brand Necessary Prior Authorization Refillable Medication Maintenance Medication Pharmacy Billing Procedure Limitations Pertinent to Drugs and Pharmacy Services Drug Utilization Review (DUR) Program Prospective Drug Utilization Review (DUR) General Requirements Prospective DUR Screen Impact on Pharmacies Patient Counseling Impact on Pharmacies Patient Profiles (Medication Records) Impact on Pharmacies Pharmacy Lock-In Program Introduction Legal Basis Enrollment of Recipients Pharmacy Lock-In - REVS Responsibilities of the Primary Pharmacy of Choice Responsibilities of the Primary Care Physician Change in Primary Pharmacy/Physician and Recipient Status Pharmacy Pricing Policy Federal Upper Limits for Multiple Source Drugs DESI Drug List Over-the-Counter Product List Drug Manufacturers With OBRA 1990 Rebate Agreements Recipient Log Recipient Log Recipient Prescription Log Prescription Signature Log Certification Pharmacist's Daily Certification Error Status Codes ESC Code List (English) Explanation of Benefits (EOB) Codes EOB Codes and Messages List (English) EOB Codes and Messages List (Spanish) Appendix - Third Party Liability Carrier and Coverage Codes Third Party Liability Carrier and Coverage Codes For specific questions you may contact the Customer Service Help Desk at (401) 784-8100 for In-state and long distance callers, or 1-800-964-6211 for In-state toll callers and border communities.