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.