Long Term Care

Coverage Guidelines

Please note that coverage guidelines and procedures are subject to change. Refer to the monthly Provider Update for more information.

• Long Term Care Coverage Guidelines
  • Claim Billing Guidelines
  • Covered Services
  • Limitations/Special Requirements
  • Non-Covered Services
  • Out of State Providers
  • Program Information
  • Prospective Reimbursement System
  • Provider Participation Guidelines
  • Recertification
  • Reimbursement Guidelines

Claim Preparation Instructions

• UB-04 Form Filing Instructions  
• Long Term Care - UB-04 Claim Form 

Error Status Codes

• ESC Code List (English) 

Explanation of Benefits (EOB) Codes

• EOB Codes and Messages List (English) 
• EOB Codes and Messages List (Spanish) 

Appendix - Third Party Liability Carrier and Coverage Codes

• Third Party Liability Carrier and Coverage Codes
  
  
  
   
• For specific questions you may contact the Customer Service Help Desk at (401) 784-8100 for In-state and long distance callers, or 1-800-964-6211 for In-state toll callers and border communities.