Provider Enrollment

Provider Participation

To participate in the RI Medicaid, providers must be located and performing services in Rhode Island or in a border community . Consideration will be given to out-of-state providers if the covered service is not available in Rhode Island, the recipient is currently residing in another state or if the covered service was performed as an emergency service while the recipient was traveling through another state.

Effective Date of Enrollment

Retroactive enrollment is limited to the first day of the month in which the application is approved. 

For specific enrollment information, refer to the Provider Participation section in the Provider Manual for your provider type.  Click here for Provider Manuals.

Instructions for Enrollment as a Medicaid Provider

Provider Enrollment in RI Medicaid has changed!

Beginning July 30, 2015, provider enrollment for the RI Medicaid Program is completed electronically through the Enrollment Portal, in the Healthcare Portal.  Paper applications are no longer accepted except for attending physicians being added to an existing group.

It is important to note the following:

  • Instructions for completing the electronic application are accessible on the homepage of the Healthcare Portal.
  • Attending providers being added to a group will continue to submit a paper application found below.
  • Effective October 1, 2015, Ordering, Prescribing and Referring (OPR) providers must be enrolled in the RI Medicaid program to order, prescribe, or refer items or services for Medicaid beneficiaries.  For more information on the claim types impacted or claims processing information, please review the Frequently Asked Questions document.

Provider Enrollment General Frequently Asked Questions (FAQ's)

If you have additional questions, please contact the Customer Service Help Desk at (401) 784-8100 for local and long distance calls or (800) 964-6211 for in-state toll calls or email to Provider Enrollment.

Screening/Enrolling as a Medicaid Managed Care Organization Provider:

The 21st Century Cures Act 114 P.L. 255 requires all Medicaid Managed Care network providers regardless of specialty to be enrolled with or screened by the State Medicaid Agency or risk being removed for the Rhode Island Medicaid Managed Care Network. Click here to find more information.

Adding a Provider, RIte Share, and LEA Providers

New Provider Joining an Existing Group
RIteShare Providers 
Local Education Agency (LEA) Providers

Enrolling as a Trading Partner

Once you are enrolled as a provider in RI Medicaid, you must  apply for a Trading Partner ID to access eligibility, claim status and remittance advice.  Applicants may access the electronic enrollment process by visiting the RI Healthcare Portal .

All existing Trading Partners are required to register in the Healthcare Portal.  Instructions are found on the Healthcare Portal page.

Revalidation of RI Medicaid Enrollment

Providers are notified by mail when they are required to revalidate enrollment with RI Medicaid. Notices are also published in the monthly Provider Update.  

Click here for instructions for revalidation   

Supplemental Application Documentation for Provider Revalidation 

Frequently Asked Questions (FAQ) for Provider Revalidation

Application Fees for Providers

Providers who are applying for either enrollment in RI Medicaid or revalidation of RI Medicaid enrollment may be required to pay an application fee.

Click here for more information 

Additional Forms

Electronic Funds Transfer (Mandatory)
W9 Form and Instructions  
RI Medicaid Disclosure Questions  
Additional Federally Required Disclosure Information    
Provider Change of Information Form 
Home Care Transportation Certification   (Mandatory for Home Care Agencies)
Home Care Transportation Policy  

Send forms to:

Gainwell Technologies/Provider Enrollment
P.O. Box 2010
Warwick, Rhode Island 02887-2010

Need help with the application process?  
Please call the Customer Service Help Desk at  (401) 784-8100 or email:  rienrollment@gainwelltechnologies.com 

LINKS

For additional information for new RI Medicaid Providers, view the Welcome New Provider presentation.

Are you using Electronic Billing?
Billing software is available at no cost to RI Medicaid Providers. Download a copy of our proprietary software Provider Electronic Solutions (PES) Software. We provide training and support to get you started.

Want to check your Claims or Prior Authorization status online?
Please visit the Healthcare Portal page for more information or to apply for a Trading Partner number.