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.
Recipient Eligibility Verification What Needs to be Verified A recipient's eligibility status may change periodically if financial and household circumstances change. For this reason, at each visit a provider must verify the cardholder's: Current eligiblity Program Enrollment Managed Care Other Insurance information Dental or Vision Limits (when appropriate) Correct spelling of the recipient's name Methods of Verification Healthcare Portal Providers may log into the Healthcare Portal to verify recipient eligibility. A Trading Partner ID is required to perform this function as well as registration in the Healthcare Portal. For instructions, see the Healthcare Portal Page. Batch Eligibility Verification (270/271 Transaction) The 270/271 transaction set allows trading partners to submit an eligibility request for multiple recipients at the same time. Trading partners can submit batch transactions directly to Medicaid using a vendor-created software program. Refer to the HIPAA Companion Guides for information on all HIPAA-approved transactions. Customer Service Help Desk Providers may choose to call the RI Medicaid Help Desk to verify a recipient's eligibility with a Customer Service Representative. The Medicaid Help Desk is available Monday-Friday from 8:00 AM to 5:00 PM. The local and long distance number is 401-784-8100 and the in-state toll call and border communities number is 1-800-964-6211.