Trading Partner Passwords

For your security, Trading Partner passwords expire every 90 days. Please follow Steps 1 and 2 in order 
to successfully change your password

Step 1

• Go to www.dhs.ri.gov

• Access “MMIS Web Transactions” by clicking on the link on the left side of the page

• Enter your Trading Partner ID and your current password

• Choose a new password and enter it twice

Step 2
If you are using Provider Electronic Solutions (PES):

• Go to Tools, Options, and on the Batch tab update your web password 

If you are using your own software:

• Change your password in the appropriate field in the software

** If you do not follow both Step 1 and Step 2, you will not be able to transmit your claims.**

If you do not have access to the Internet, please call Paula Giocastro at 401-784-3817

ClaimCheck Update

The Rhode Island Medical Assistance Program (RIMAP) is continually reviewing ways to further improve 
our claims processing accuracy and consistency by employing the latest in proven computer technology.

On October 4, 2004 EDS implemented ClaimCheck®, an expert system that assists in evaluating the 
accuracy of submitted CPT® and HCPCS codes. By “thinking” the same way a physician-reviewer would, 
ClaimCheck uses a clinical knowledge base that results in a medically based recommendation. This review 
will go back to July 1, 2004, to evaluate paid claim accuracy. If the paid claims are incorrect they may be 
subject to an adjustment or recoupment. The outcomes may be one of the following:

• To accept the code(s) as submitted

• To consider changing the submitted code(s) to comply with generally accepted coding 
  practices that are consistent with the American Medical Association’s (AMA) CPT manual, 
  the Centers for Medicare and Medicaid Services, (CMS), HCPCS Level II Codes manual, 
  as well as the opinions of prominent physicians within the medical specialty

• To seek additional information from the physician’s office because there is inconsistent 
  information on the claim

• To deny the claim based on clinical review

ClaimCheck evaluates the coding accuracy of the procedure(s), not the medical necessity of the 
procedure(s). The types of services that will be evaluated by ClaimCheck are as follows:

• Policies based on the CPT manual

• Policies based on health care coding standards

• Bundling/Unbundling of procedures

• Global periods (pre and post surgery)

• Multiple procedures performed same day

• Appropriateness of assistants at surgery

• The proper use of modifiers 

The procedural determination is gathered through resources such as the Center for Medicare & 
Medicaid Services, Federal Register, CPT, HCPC, American College of Surgeons, Code Auditing 
Advisory Committee and (but not ending) a board of Specialty Physicians across America. This type 
of editing has been in place in all Blue Cross Blue Shield commercial carriers as well as a multitude 
of others.

Thank you for your continued support and the quality care you provide to our members. If you have 
any questions or concerns please contact Provider Services at 1-800-964-6211 for instate toll calls 
and bordering communities or 401-784-8100 for long distance callers. 

Provider Refunds

When submitting a provider refund, a completed RI Medical Assistance TITLE XIX Refund Form 
must be included with the check. Click here for a copy of this form. The following items must 
be listed on the form:

• Correct Provider Name and Number

• Recipient Name and Medical Assistance Identification Number 

• Internal Control Number (ICN), the 15 digit number used to identify the claim (The Customer 
  Service Help Desk will retrieve this number upon request)

• Date of Service

• Date of Remittance Advice on which claim was paid

• Dollar amount of original claim

• Reason for refund

For efficient refund processing, the following guidelines should also be followed:

• Include a copy of the page from the Remittance Advice on which the claim was paid. 
  The ICN and the recipient Medical Assistance Identification number of the claim that is being 
  refunded should be highlighted.

• Refrain from stapling the check(s) and documentation.

• If the refund is for more than one claim, complete all fields on the Refund Form for each 
  individual claim.

IMPORTANT: If there is no supporting documentation included with the provider refund check, it 
will result in a non-claim specific refund. A non-claim specific refund will be posted on your RA 
under “Financial Items”. It will not indicate the ICN, recipient information, or dates of service. 

All refund checks should be made payable to the State of Rhode Island and mailed to:

EDS
PO Box 2010
Warwick, RI 02887-2010
Attn: Financial

Questions can be directed to the Customer Service Help Desk at 1-800-964-6211 for instate toll 
calls and bordering communities or 401-784-8100 for long distance callers or your Provider 
Representative.

New Check Format for Provider Payment

If you currently receive a paper check with your Remittance Advice payment, you will soon notice 
that your checks will be printed on new paper stock, which will be sized as an 8 x 10 sheet of paper. 
The check, which will be at the top of the page, will continue to have the check information listed and 
will have perforated edges for detaching. 

The EDS logo along with your provider name and check number will continue to be listed on the new 
check stock. The issuing bank name, routing and account numbers will remain the same. 

EDS Gift Policy

EDS would like to take this time to remind all of our business partners including providers and suppliers 
that we are committed to providing high-quality, professional services and to conducting our business 
ethically and with integrity. As Fiscal Agent and as a corporation we earn our reputation as an honest and 
ethical organization by applying consistently high standards in all our relationships. Responsive customer 
service is also our mission and responsibility. Therefore, it is our policy that our staff refrain from accepting 
any type of gifts. Thank you for understanding our position and corporate policy in this matter. 

Changing Your Address

Please remember that it is necessary to notify Provider Enrollment at EDS as soon as possible when any 
address information is changed. This will ensure that you continue to receive key correspondence from the 
Rhode Island Medical Assistance Program (RIMAP). The change of information form that must to be 
completed to report such a change can be found on the Department of Human Services Website under 
“Provider Forms”. Your RIMAP provider number must be listed on this form. It may be faxed to the 
attention of the Enrollment Department at 401-467-9581 or mailed to: 

EDS
P.O. Box 2010
Warwick, Rhode Island 02887-2010
Attn: Enrollment

Feel free to contact the Customer Service Help Desk at 1-800-964-6211 for instate toll calls and bordering 
communities or 401-784-8100 for long distance callers with any questions on how to complete the form.

DHS Holiday Observations for 2005

The Department of Human Services will be closed on the following days:
Monday, January 3rd	New Year’s Day (observed)
Monday, January 17th	Dr. Martin Luther King, Jr. Day
Monday, May 30th	Memorial Day
Monday, July 4th	Independence Day
Monday, August 8th	Victory Day
Monday, September 5th	Labor Day
Monday, October 10th	Columbus Day
Friday, November 11th	Veterans’ Day
Thursday, November 24th	Thanksgiving Day
Monday, December 26th	Christmas Day (observed)

A Reminder From the Surveillance Utilization Team

The Medicare guideline for diabetic shoes, fitting and modifications specifically reads, “Documentation 
from the prescribing physician must certify the diabetic patient has one of the following conditions”:

• Peripheral neuropathy with evidence of callus formation

• History of pre-ulcerative calluses

• History of ulceration

• Foot deformity

• Previous amputation

• Poor circulation

Please note: The footwear must be fitted and furnished by a podiatrist, pedorthist, orthotist, or prosthetist

Holiday Greetings

During this holiday season the Department of Human Services and EDS thank you, the Rhode Island 
Medical Assistance provider community, for the services you provide our clients. We enjoy working 
with you and look forward in the upcoming year to our continued collaboration in support of families 
and the goals of the Medical Assistance Program. May you have safe and happy holidays.