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.