Provider News

Physician and Outpatient Hospital Providers

The Equality in Abortion Coverage Act (EACA) was signed into law by the State of Rhode Island on May 18, 2023. Under the law, the EACA will provide insurance coverage for abortion care to individuals on Medicaid to increase access and reduce financial limitations of reproductive health care at the state level. The legislation (2023-S 0032, 2023-H 5006) eliminates sections of the law that expressly prohibit the state’s Medicaid programs from covering any abortion, except in cases of rape or incest or when the completion of the pregnancy would be life-threatening.

Historically, reimbursement for an abortion required providers to submit a form documenting that the reason for the abortion was rape or incest or because completion of the pregnancy would be life-threatening. In the event, that one of these conditions applies, providers should continue to follow that process.

To be paid for abortions newly eligible for payment under the EACA, providers should bill the applicable abortion CPT code with the modifier FP (SERVICE PROVIDED AS PART OF MEDICAID FAMILY PLANNING).  Claims billed without the new FP modifier will continue to deny unless accompanied by the required form described above.

Effective for dates of service on or after May 18, 2023, the following CPT codes can be billed with the FP modifier:

  • 59840-FP         59841-FP         59850-FP
  • 59851-FP         59852-FP         59855-FP
  • 59856-FP         59857-FP         59866-FP
  • S0190-FP         S0191-FP        S0199-FP

For questions, please contact Karen Murphy at or (571) 348-5933.


Bridge Closure/Late Fees for RI Medicaid Recipients

Please be advised that RIDOT has closed the westbound side of the Washington Bridge/I-195 West due to the discovery of the critical failure of some bridge components.  To ensure ongoing access to needed care and services, providers are reminded that imposing late fees, balance billing, and/or termination of beneficiaries who miss or are late to appointments due to the bridge closure is not allowable. We ask that providers support and accommodate beneficiaries affected by this closure to ensure that needed care and services are delivered timely. 

Kristin Sousa, Medicaid Program Director 


Electronic Secondary  Billing for Medicare and Senior Replacement Plans

Please view billing instructions if using the Provider Electronic Solutions Software.  The appropriate Carrier Codes can be found in the table below.


Electronic Secondary Billing for Medicare and Senior Replacement Plans

To facilitate electronic billing and proper reimbursement for Medicare and Commercial Medicare Plans (Advantage/Replacement Plans) such as United Senior Care, Blue-Chip Medicare HMO, WellCare Advantage Plan the following fields are required:

  • Loop 2320 Other Subscriber Information SBR09 - Must contain MA or MB as appropriate for the claim filing indictor
  • Loop 2320 Claim Level Adjustments CAS segment - Must contain Deductible PR 1 or Coinsurance of PR 2
  • Loop 2320 Coordination of Benefits (COB) Payer Paid Amount – Must contain the Amount Paid (other insurance paid amount)
  • Loop 2330B Other Payer Name (Carrier Code) Segment NM109 Other Payer Primary Identifier – Must contain the appropriate carrier code, see below for a list:

MDA/MDB – Medicare

22A – Aetna Medicare Advantage Plan

06A – United Senior Care

24A – Connecticare Medicare Advantage Plan

08A – Healthfirst Medicare Advantage Plan

26A – Humana Medicare Advantage Plan

09A – HMO Blue of Massachusetts Advantage Plan

26B – Humana Medicare Advantage Dental Plan

12A – Blue Chip Medicare HMO

89A – Tufts Health Plan (PPO) Medicare Advantage Plan

18A – Wellcare Medicare Advantage Plan

C01 – CarePlus Advantage Plan

19A – MMM Healthcare of Puerto Rico Advantage Plan

C02 – Commonwealth Care Alliance, Inc. Medicare Advantage Plan


Durable Medical Equipment Providers

Effective 3/1/23, Rhode Island Medicaid Fee-for-Service will be activating coverage for HCPCS code K1005 - Disposable collection and storage bag for breast milk, any size, any type.  Reimbursement is $0.24 per unit with a maximum of 120 units per month. 

No prior authorization is required.  Vendor must verify continued medical necessity for lactating members on a monthly basis prior to delivering refills for this item per DME regulations detailed on page 11 of the DME Provider Manual under Refill Requirements.  This item must be billed monthly.  Three-month and/or automatic shipments are not permitted. 


Attention Assisted Living Facilities (ALF) Providers

Effective January 1, 2023, the monthly Room and Board Rate for all Medicaid LTSS Assisted Living customers will change to $1,246.00 to reflect the Year 2023 Federal Benefit Rate (FBR).  Cost of Care (COC) may also change to reflect the 2023 COLA for customers who are receiving SSA benefits.  For customers with income below $1,246.00, their R&B may be less. 

For assistance, questions, or concerns, please contact:

LTSS Coverage: 401-574-8474 or DHS Coverage: 1-855-697-4347 or the LTSS Email: . 

For Cost of Care (COC) and Room and Board updates and discrepancies, please contact:

OHHS Contacts:   or 



Provider Updates have been moved to another page.

Click here to be redirected.