Attention RI Medicaid Members: Update on Prescription Access Due to a cybersecurity issue, a contractor serving pharmacies and Medicaid programs across the US is unable to provide important online services at this time. In Rhode Island, this situation impacted pharmacies’ ability to fill prescriptions for members of the AIDS Drug Assistance Program (ADAP) and the Medicaid Program. In response, RI EOHHS has quickly brought online a new way for pharmacies to process claims. Rhode Island Medicaid has also told pharmacies that they can provide a 30-day supply of any prescriptions you are trying to fill, to help you get through this time. The pharmacy should not charge you for any prescription that is covered by Medicaid. Learn more.
RI Medicaid Program HIPAA 5010 January 1, 2012 was the compliance date for the 5010 transactions. This final rule mandates adoption of newer versions of the original HIPAA standard transactions. Rhode Island is now compliant with CMS requirements for the 5010 & NCPDP D.O standards. As of February 18th, 2012, we no longer accept 4010 transactions. At this time, we are only accepting the 5010 format for the following transaction sets: 837P, I and D – Professional, Institutional and Dental 270 and 271 – Eligibility Inquiry and Response 277U – Unsolicited – Health care claim status 835 – Health care payment and remittance advice NCPDP D.O. – POS Retail Pharmacy Drug and Professional Services If you are a Provider Electronic Solutions software user (PES) you should be using the most current version. The newest version can be found on the Provider Electronic Solutions web page. If you need any assistance upgrading to the current version, please contact our EDI Coordinator Mary Jane Nardone at 401-784-8014 or mary-jane.nardone@gainwelltechnologies.com. RI Medicaid HIPAA Companion Guide The RI Medicaid Companion Guide includes the technical specifications for the: 837 version 5010 for institutional, professional and dental electronic claims 999 functional acknowledgement 277 unsolicited claim response 835 electronic remittance 270/271 Eligibility Request/Response These specifications are to be used in conjunction with the National Electronic Data Interchange Transaction Set Implementation Guides to provide supplemental information specific to RI Medicaid as permitted within the structures of the HIPAA transaction sets. Information pertaining to the Gainwell Technologies translator, interface specifications, the Trading Partner Agreement, Provider Services contacts, and HIPAA resources are also contained in this document. HIPAA RI Companion Guide 5010 Standard Companion Web Interface NCPDP D.0 Payor Sheet Frequently Asked Questions RI 276 277 Real Time Guide RI 270/271 Batch and Real Time Guide Other Resources The Centers for Medicare & Medicaid Services (CMS) CMS Educational Resources WEDI Information For additional information visit RI Health Insurance Portability & Accountability Act (HIPAA)