Provider News

Attention Nursing Home Providers

To improve the timeliness of the nursing home billing process, EOHHS has eliminated the requirement to submit discharge and readmission slips in CSM for members that meet the below criteria: 

  • Members have long term care approval and discharge from a nursing facility for an inpatient hospital stay.
  • Hospital admission is for 30 days or less
  • Readmission is back to the same nursing facility that the member was discharged from.

This change impacts all dates of service and skill levels and was implemented on February 22, 2021.  Here is an example for billing.

Important - If a member discharges to the hospital and it is for more than 30 days, then it is required that you submit the discharge and readmission slips into CSM as you do today. 

For any questions please reach out to .

Attention Provider Electronic Solutions (PES) Users

A new version of PES is now available and you should update to this version as soon as possible.  Failure to update to this version will create an issue with claims processing when you are submitting claims that have a zero-dollar paid amount on the other insurance tab.

In order to correct this issue, we have created a new PES Version 2.12.  You can follow the link at the end of this email to download the latest version of the software. It is critical that you follow the upgrade instructions carefully.  Otherwise you run the risk of corrupting your database.  Before beginning the upgrade installation, we recommend that you create a backup copy of your database.  This would be used in the event your file is corrupted during the upgrade process. 

Instructions to create your backup for your existing database:

Navigate to you where your database is stored. For some of you that would be the C drive/RIHIPAA folder.  For others it would be the server/RIHIPAA folder.
The database file is named rinewecs.mdb. Right-click and choose copy. Next, navigate to your desktop or a flash drive folder. Right-click and choose paste. This file is only to be used if your upgrade to version 2.12 doesn’t work and your database is corrupted.

Once your database is saved, proceed to the Upgrade.  The software upgrade and upgrade instructions can be located on the Provider Electronic Solutions page on the EOHHS website. 

When your upgrade to version 2.12 is successful, you can delete what you saved on your desktop or the flash drive.  We highly recommend you delete the saved copy from your desktop or flash drive.

If you should have any questions, please email or contact your provider representative.

Hospital Providers

This notice is to inform you that effective, today, October 1, 2020; all Rhode Island Medicaid Utilization Review processes will be transferring from Qualidigm to IPRO, who will become the RI Medicaid Utilization Review agent.

IPRO is a nationally recognized QIO (Quality Improvement Organization) with extensive experience in healthcare quality programs federally and is the longtime New York Medicaid Review agent.

Qualidigm is working with IPRO and the RI EOHHS to ensure that the transition of review services including all screening, concurrent review and authorizations are complete, with minimal disruption to providers and patients. Telephone numbers for authorizations will remain unchanged.

Should you have any questions please contact Wendy P Ferguson, Senior Director of Review, IPRO at or (516) 209– 5378/5592.

Emergency Case Management

Effective April 1, 2020, Emergency Case Management services for the homeless population has been approved for the duration of the COVID-19 crisis.  Homeless Service Agencies and Homeless Shelters providing these services will need to enroll in RI Medicaid.  

Here is the link for the on-line Provider Enrollment Application.  Here is an Enrollment Guide to assist you with the enrollment process.

RI Medicaid will be reimbursing Emergency Case Management services at $12.13 per unit.  A unit is 15 minutes, maximum units allowed per day are 4.  The procedure code to bill this service is T1017.

Click here for guidelines.

3/9/2020: See memo regarding COVID-19 and telehealth here.



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