Rhode Island Medicaid — Rhode Island Medicaid (RIte Care / Rhody Health Partners)
| Program name | Rhode Island Medicaid (RIte Care / Rhody Health Partners) |
|---|---|
| Provider portal | https://eohhs.ri.gov |
| FFS claims payer ID | No single canonical ID — routing is fiscal-intermediary-specific. Verify per clearinghouse. |
| Medicaid timely filing | 365 days from date of service |
The federal ceiling for Medicaid timely filing is 12 months under 42 CFR §447.45; most states set a shorter window. Always verify the current policy on the Rhode Island Medicaid provider portal before filing a late-billing appeal.
BCBS licensee in Rhode Island
The Blue Cross Blue Shield Association licensee in Rhode Island is Blue Cross & Blue Shield of Rhode Island. This licensee is not yet in the QuickIntell payer registry. See the full payer directory or the BCBSA national site for a provider-portal link.
Top commercial payers in Rhode Island
The dominant commercial insurers operating in Rhode Island, in approximate order of lives covered. Click through for per-payer claims payer IDs, timely filing windows, prior-authorization rules, and appeal procedures.
Medicaid MCOs in Rhode Island
Rhode Island Medicaid (RIte Care / Rhody Health Partners) contracts with the following managed-care organizations to administer Medicaid benefits in Rhode Island. MCO contracts dictate claims routing, prior-auth workflows, and appeal deadlines — route each claim by the member's MCO assignment, not the state FFS payer ID.
Medicare contractor and active LCDs in Rhode Island
Wellpoint Federal is the Medicare A/B MAC for Rhode Island: Part A and Part B fee-for-service claims from Rhode Island go to it, and its Local Coverage Determinations decide local medical necessity. Durable medical equipment and supply claims go to Noridian Healthcare Solutions, LLC as the DME MAC. Home health and hospice claims are processed by Wellpoint Federal. In the current Medicare Coverage Database export, 147 active LCDs from these contractors apply to Rhode Island claims.
- Wellpoint Federal
A/B MAC (Part A and Part B claims); Home health and hospice MAC
- Noridian Healthcare Solutions, LLC
DME MAC (durable medical equipment and supplies)
Selected active Wellpoint Federal policies for Rhode Island
A selection, not the full list: policies with measured search demand come first, then those on topics that more contractors publish LCDs for.
- L33627 Non-Invasive Vascular Studies
- L33394 Drugs and Biologicals, Coverage of, for Label and Off-Label Uses
- L35936 Facet Joint Interventions for Pain Management
- L39036 Epidural Steroid Injections for Pain Management
- L35000 Molecular Pathology Procedures
- L33577 Transthoracic Echocardiography (TTE)
- L33631 Outpatient Physical and Occupational Therapy Services
- L33632 Psychiatry and Psychology Services
- L33557 Cardiac Catheterization and Coronary Angiography
- L33569 Percutaneous Vertebral Augmentation (PVA) for Osteoporotic Vertebral Compression Fracture (VCF)
- L33636 Routine Foot Care and Debridement of Nails
- L33622 Pain Management - Injection of tendon sheaths, ligaments, bursa, and ganglion cysts
Equipment, home health and hospice policies that apply in Rhode Island
- L33822 Glucose Monitors
- L33789 Power Mobility Devices
- L33318 Knee Orthoses
- L33686 Ankle-Foot/Knee-Ankle-Foot Orthosis
- L33718 Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea
- L33792 Wheelchair Options/Accessories
- L33797 Oxygen and Oxygen Equipment
- L33393 Hospice - Determining Terminal Status
Steps to confirm which LCD governs a claim · Every active LCD by contractor
State-specific regulations affecting Rhode Island billing
- R.I. Gen. Laws §27-18-81 (RI Balance Billing consumer protections, 2017)
- R.I. Gen. Laws §27-18-61 (prompt pay — 40 days electronic clean claim)
- R.I. Gen. Laws §23-17-54 (hospital financial assistance)
Provider licensing & enrollment in Rhode Island
Providers enroll via EOHHS Healthcare Portal (Gainwell MMIS). RIte Care MCOs credential through CAQH ProView.
Major health systems headquartered in Rhode Island
| Health system | Headquarters |
|---|---|
| Lifespan (Rhode Island Hospital) | Providence, RI |
| Care New England | Providence, RI |
| CharterCARE Health Partners (Prospect) | Providence, RI |
| South County Health | Wakefield, RI |
| Landmark Medical Center (Prime Healthcare) | Woonsocket, RI |
Frequently asked questions — Rhode Island billing
What is the Rhode Island Medicaid program called?
Rhode Island's Medicaid program is known as Rhode Island Medicaid (RIte Care / Rhody Health Partners). Providers enroll and manage claims through the provider portal at https://eohhs.ri.gov.
What is the Rhode Island Medicaid timely filing limit?
Rhode Island Medicaid (RIte Care / Rhody Health Partners) requires initial claims to be filed within 365 days from the date of service. The federal ceiling is 12 months under 42 CFR §447.45; Rhode Island's 365-day window is set by the state provider manual. Late-billing exceptions may be allowed with good-cause documentation — verify on the state portal before filing an appeal.
Does Rhode Island Medicaid publish a single claims payer ID?
No single canonical claims payer ID is published for Rhode Island Medicaid (RIte Care / Rhody Health Partners). Claims route through the state's fiscal intermediary; look up the correct submitter ID in your clearinghouse directory (Availity, Change Healthcare/Optum, Waystar) and route managed-care claims by the member's MCO assignment.
Who are the largest commercial insurers in Rhode Island?
The dominant commercial payers in Rhode Island include Tufts Health Plan, UnitedHealthcare, Aetna, Cigna, Humana, along with the BCBS licensee Blue Cross & Blue Shield of Rhode Island. Each payer's claims routing, timely filing, and prior-auth rules differ — see the per-payer guides linked above.
What Medicaid managed-care organizations operate in Rhode Island?
Rhode Island Medicaid (RIte Care / Rhody Health Partners) contracts with 2 Medicaid MCOs tracked in the QuickIntell registry, including Tufts Health Plan, UnitedHealthcare. MCO contracts determine claims routing and appeal deadlines — route each claim by the member's MCO assignment, not by the FFS payer ID.
What state-specific billing regulations apply in Rhode Island?
Rhode Island has 3 tracked state-level statutes that affect medical billing and RCM: R.I. Gen. Laws §27-18-81 (RI Balance Billing consumer protections, 2017); R.I. Gen. Laws §27-18-61 (prompt pay — 40 days electronic clean claim); R.I. Gen. Laws §23-17-54 (hospital financial assistance). These sit on top of federal protections such as the No Surprises Act, HIPAA, and 42 CFR §447.45.
Run cleaner claims in Rhode Island with QuickIntell
QuickRCM, QuickAuth, and QuickERA are tuned to Rhode Island Medicaid (RIte Care / Rhody Health Partners) and the commercial payers on this page — eligibility, prior auth, claim scrubbing, and ERA posting all run on real payer rules, not generic adapters.
Disclaimer
This page is operational reference for medical-billing professionals. It is not legal, clinical, or contractual advice. State Medicaid policies, MCO contracts, and payer rules change without notice — always verify against the current provider manual from Rhode Island Medicaid and the member ID card before submission.