Billing And Claims

Welcome to the RI Medicaid Program! We are committed to helping you every step of the way. This section explains the basic standards required for billing and claims processing. If you are a new provider check out the Welcome to Medicaid - New Provider e-Learning.

Fee Schedule

Medicaid Fee Schedule

Recipient Eligibility Verification

Recipient Eligibility Verification: What needs to be verified and tools that can be used to verify a recipient's eligibility.

Member Id Conversion

In September 2016, RI Medicaid converted member identification (MID) numbers, formerly 9 digit social security numbers, to a randomly generated 10 digit ID number. Providers should make note of the new ID number, as well as request that the beneficiary produce their Medicaid Identification cards. There is not a dual window for claims processing, meaning that members' 9 digit social security numbers are invalid and providers must include 10 digit MIDs on all claims.

The dual processing for claims ended on April 30, 2018.

Claims submitted with a From Date of Service after 4/30/2018 are only accepted with 10 digit MIDs. If an adjustment to a previously paid claim needs to be submitted after 4/30/2018 for a claim with dates of service before 4/30/2018, then either the 9 digit or 10 digit MID will be accepted. Providers may still enter the social security number in the Healthcare Portal when verifying eligibility. When the eligibility response is returned, the 10 digit MID will be listed for the beneficiary's ID.

Third Party Insurance

Third Party Insurance: Third party insurance codes, forms, and requirements for billing RI Medicaid.

Prior Authorization

Prior approval (PA) may be required for some services, products or procedures to verify documentation for medical necessity. Read more about Prior Authorization.

Medicaid Reimbursement Guide

Please review the Medicaid Reimbursement Guide for information on allowable Medicaid expenditures. The guide includes links to federal guidelines and State Plan pages for specific provider types.