Important - All Trading Partners

One of the new services available for Trading Partners through the DHS Website is the Message Center. This message center enables providers to receive Notification or Alerts from the Rhode Island Medical Assistance Program quicker than before. Messages could be sent to all providers or a particular grouping. You should regularly check the Message Center for important information. If you do not have a Trading Partner ID please contact the Customer Service Help Desk at 401-784-8100 or 1-800-364-6211 (in state toll call). 

Rite Care Enrollment of Children with Special Health Care Needs

Since September 2003, over 2,700 children with special health care needs have been enrolled in the RIte Care Program and Neighborhood Health Plan (NHPRI). RIte Care is Rhode Island’s Medicaid managed care program that provides health insurance coverage through a health plan. Families can access care management services by choosing to enroll their child with special health care needs in NHPRI. 

What does this mean to you?

Prior to enrolling in NHPRI, most of these children received medical services through the Fee for Service Medical Assistance Program. Clients you are serving may have transitioned to RIte Care. As a provider it is your responsibility to check eligibility on every recipient that you provide services to. You need to know if the services will be provided through Fee for Service or RIte Care. If you do not check eligibility and their eligibility changes your claims could be denied.

EDS currently has two ways for you to check eligibility.

If you are a Trading Partner, you can check eligibility by accessing the DHS Website. Once you are on the web site, please choose MMIS Web Transactions. Enter your Trading Partner ID and password. This will bring you to a menu and you can choose Check Eligibility Status. 

The second way to check eligibility is through If you are already a provider with NHPRI follow the procedures of the health plan If you are not a provider with Neighborhood, you will want to contact Neighborhood to discuss your enrollment. You may contact Crystal Ramos at 401-45-6603.  our automated eligibility line. The telephone number for REVS is 1-800-964-6211 for in-state toll calls and bordering communities and 401-784-8100 for long distance callers. You will be prompted to enter your Provider number, as well as the recipients ID and the Dates of Service you are looking for. 

If the recipient is on Neighborhood Health Care this information will be reported to you. If the recipient is on Neighborhood Health Care you will need to bill Neighborhood, as this is the recipient’s Medicaid policy. However, some services will still need to be billed to EDS for payment, for example, Dental. If you are not sure if the service you are providing should be billed to Neighborhood or EDS, you may contact the Customer Service Help Desk at 1-800-964-6211 for in-state toll calls and bordering communities and 401-784-8100 for long distance callers.

If you are already a provider with NHPRI follow the procedures of the health plan If you are not a provider with Neighborhood, you will want to contact Neighborhood to discuss your enrollment. You may contact Crystal Ramos at 401-45-6603. 

Long Term Care

Please remember that multiple detail billing is not allowed. If you need to bill more than one detail in a month or for multiple months, you must start a new header for each detail.

For example:

• If your resident has a Bill Type (RPL) change during the month, you will need to start on Header 1 again for the second segment of the month.
• If the resident is discharged during the month and then returns during the same month, you will need to start on Header 1 for the readmit.
• If the resident has just been approved for LTC retroactively, and you need to bill for multiple months, you will need to start on Header 1 for each month

If you have any questions regarding this, please contact Kelly Leighton at 401-784-3823.