Provider News

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. 



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