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Trading Partner Agreement

Any business entity who will exchange electronic data with Rhode Island Title XIX and/or utilize the new functionality available through the RI Medicaid Web Portal, will be required to complete a Trading Partner Agreement (TPA) with Rhode Island Department of Human Services (DHS) and its fiscal agent, Electronic Data Systems.  The Medicaid portal will be utilized to upload claims, download remittances and provide interactive eligibility verification and claims status, prior authorization inquiry, NDC lookup, message center, and remittance payment verification.

Each billing provider, clearinghouse, or billing service who will directly exchange electronic data with EDS must complete and sign the Trading Partner Agreement (TPA).  The TPA must list all RI Medicaid Provider Numbers, for whom the Trading Partner submits electronic claim(s), will access electronic remittance advice(s), check claim status and/or check eligibility status.  RI Title XIX providers who utilize a Third Party to exchange data with EDS, must identify the transactions that the Third Party is authorized to perform on their behalf, and indicate Consent by an authorized signature on the TPA.  Providers who do not exchange electronic data directly with EDS are not required to complete a TPA.

Click here to download the Trading Partner Agreement

Click here to download the Trading Partner Agreement ID Change/Add form

 

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