Attention Providers: Change Healthcare Update Change Healthcare (CHC) can resume submitting claims to RI Medicaid. This means if you are doing business with CHC, they can submit your claims to RI Medicaid and CHC can now resume downloading your 835/277unsolicited transactions.Please reach out to your clearing house representative with any questions you may have regarding the submissions. You can also reach out to riediservices@gainwelltechnologies.com.
Forms & Applications Consumer Applications To apply for health and human services see the consumer section of this website. Individuals and families can apply online, mail in a completed paper application or apply by phone. When applying for any program, accompanying documents are usually required. For information on Katie Becket and how to apply, see Katie Beckett. For information on Medicaid Long-Term Services and Supports (LTSS), see Medicaid LTSS. Application for State Assistance to Pay for Healthcare Coverage Forms Access to Public Records Requests (APRA): APRA Information & Guidelines APRA Request Form Changes to Medicaid LTSS: LTSS Change Report Form Home Care Information: Home Care Services Request Form and Instructions (for former RHO Unity members) Electronic Visit Verification (EVV) Info (for former RHO Unity members) Long Term Care Forms: Referral for Preventive or Medically Complex Needs (GW-OCP) Request for Level of Care/Cover Sheet (GW-RR) Medical Evaluation of Applicant for Level of Care (GW_OMR-PM-1) Nursing Home Transition Program Referral Form (GW-REF) Medicaid Managed Care Member Reenrollment Medicaid Managed Care Member Reenrollment Member Request Form Notice of Privacy Practices: Notice of Privacy Practices Personal Needs Fund: Personal Needs Fund Regulations Personal Needs Fund Authorization Document Exhibit B Exhibit C