Health Plans for Individuals and Families.To find the reimbursement amount for a CPT or HCPCS code, go to Fee Schedules. Refer to Third Party Liability for the appropriate code. The 3 digit carrier is required for claim with a primary insurance. Third Party Liability (TPL) Carrier Codes Use the Healthcare Portal (Please see the Healthcare Portal page for information on how to register or use the site) or call the Customer Service Help Desk to find out if a recipient is eligible for Medicaid.įor information on how to obtain Prior Authorization. Third Party Liability Procedural Information Recoupment Form Recoupment Form Instructions A copy of the the Remittance Advice page is required with the Adjustment Form in order for processing.Īdjustment Form Adjustment Form Instructions By calling the RI Medicaid Customer Service Help Desk at 40 for local and long distance calls or 1-80 for in-state toll call and border communities.Ĭlaim Adjustment Forms and Other Related FormsĬlaim adjustments can only be performed on Paid Claims.Providers can check claim status on the Healthcare Portal (Please see the Healthcare Portal page for information on how to register or use the site) or.To initiate the automatic deposit process, providers must complete and return the EFT Authorization Form and attach a voided check to confirm the provider's account number and bank transit number.Ĭlaims Processing and Payment Schedule - Claims are processed for payment approximately every two weeks. All payments will be made electronically by automatic deposit into the account specified on the Provider's Electronic Funds Transfer form. The RI Medicaid Program no longer issues paper checks for claims payment. The claim and supporting documentation to prove timely filing must be submitted on the appropriate paper claim form to your Provider Representative. If the client has other insurance and the claim is past the 365 day limit then an exception will be allowed to process the claim if the other insurance EOB is within the past 90 days. NDC Attachment Form Instructions Time Limits for Filing ClaimsĪll Medicaid claims must be received within 365 days of the first date of service in order to be accepted for processing and payment. Reminder: CMS 1500 Version 02/12 is required after April 1, 2014, regardless of date of service. All paper claims and documentation should be mailed to: invoice documentation for DME supplies, if required). Submission of paper claims is available for those claims that require attachments (i.e. For more information, please contact your Provider Representative. Gainwell Technologies Provider Representatives will assist you and get you started. Download a copy of the software and try it for free- Provider Electronic Solutions. Provider Electronic Solutions software is available for RI Medicaid Providers. All electronic transactions must be HIPAA compliant. Providers who want to submit claims electronically - whether through a clearinghouse, with software obtained from an approved vendor, or through Provider Electronic Solutions software - must complete an online Trading Partner Agreement Application in the Healthcare Portal. Medicaid State Plan Scanned PDF Version.2021 Medicaid Managed Care Member Survey.FPL Guidelines And Eligibility Information.Nursing Home Isolation Unit Supplemental Funding. HCBS Workforce Recruitment and Retention.Home and Community-Based Services (HCBS) Access Program.
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