Claim Submission and Payment Schedule

Below please find the Rhode Island Medical Assistance Program Claim Submission and Payment Schedule 
for January through July 2005:

MONTH	LTC Claims Due by Noon	Electronic Claims Due	Cycle Date	EFT Payment Date
January	01/06/2005	01/07/2005	01/08/2005	01/14/2005
		01/21/2005	01/22/2005	01/28/2005
February	02/10/2005	02/11/2005	02/12/2005	02/18/2005
		02/25/2005	02/26/2005	03/04/2005
March	03/10/2005	03/11/2005	03/12/2005	03/18/2005
		03/25/2005	03/26/2005	04/01/2005
April	04/07/2005	04/08/2005	04/09/2005	04/15/2005
		04/22/2005	04/23/2005	04/29/2005
May	05/12/2005	05/13/2005	05/14/2005	05/20/2005
		05/27/2005	05/28/2005	06/03/2005
June	06/09/2005	06/10/2005	06/11/2005	06/17/2005
		06/24/2005	06/25/2005	06/30/2005
July	07/07/2005	07/08/2005	07/09/2005	07/15/2005

RIte Care Reminder

When verifying recipient eligibility via the Recipient Eligibility Verification System (REVS) line, the Department 
of Human Services (DHS) Website, or the Customer Service Help Desk, you may be informed that a recipient 
is enrolled in RIte Care with Coordinated Health Partners/Blue CHiP, Neighborhood Health Plan, or UnitedHealth 
of New England. Please be advised that RIte Care in-plan services should be billed directly to the particular 
health plan through which the recipient is covered rather than to EDS. In addition, an in-plan service paid 
or denied by a RIte Care health plan should not be billed to EDS as a secondary coverage. If you would 
like more information to determine which services are in-plan for RIte Care and which are out-of-plan, please refer 
to your Provider Reference Manual or your online manual located on the DHS Website

A Thank You For Keeping In Touch

The team at EDS would like to thank all the providers who contact our Customer Service Help Desk (CSHD) 
everyday. Our goal is that each time you call your experience is a pleasant one and you find the representatives
to be helpful, courteous, and knowledgeable.

Because of the large volume of incoming calls, a representative that you have worked with in the past may be 
assisting another provider at the time of your call. We assure you, however, that all representatives look forward to 
the opportunity to address any issues you might have and will gather any information necessary to answer your 
questions thoroughly. We appreciate your willingness to allow the representative who receives your call to support 
your needs, as it is essential in ensuring that all calls are answered in a timely manner.

LTC Claim Submission Deadline

Long Term Care claims for December 2004 are due on January 6, 2005 by 12:00 noon. Please, be advised, 
however, that EDS and DHS will be closed on Monday, January 3, 2005 in observance of the New Year’s Day 
Holiday. Although claims may still be sent on January 3rd, we will be unable to address any questions regarding 
your submission until Tuesday, January 4, 2005 when the offices reopen.

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

Vision Service Limits

• The Rhode Island Medical Assistance Program allows recipients age 21 and older coverage for 1 visual 
  analysis and either 1 pair of eyeglasses (lenses, frames and dispensing fee) or 1 pair of contact lenses 
  (if medically necessary) per 24-month period.
  

• Prior to verifying whether a recipient over 21 years of age has exhausted vision benefits, providers should 
  confirm recipient eligibility for the date of service to ensure claim payment.
  

• In order to verify that a recipient over 21 years of age has not exhausted vision benefits, you may utilize the 
  Department of Human Services (DHS) Website or the Recipient Eligibility Verification System (REVS) line. 
  If you need further assistance or would like to obtain the specific date on which benefits were last used, you 
  may contact the Customer Service Help Desk (CSHD) at 1-800-964-6211 for instate toll calls and bordering 
  communities or 401-784-8100 for local and long distance calls. 
  

• Recipients under the age of 21 are not subject to limitations on any type of vision service. However, documentation 
  to support the medical necessity of such services must be maintained in the recipient’s records. 
  

Procedure Code Modification

Effective January 1, 2005, the unit definition of procedure code A4927 (Gloves, Non-Sterile, per 100) will be altered 
by EDS to reflect HCPCs policy. Currently, when billing EDS, one unit of A4927 represents one single glove. As of 
January 1, 2005, one unit of A4927 will be updated to indicate one box of 100 gloves. Please take note of this change 
and bill accordingly.