Official State of Rhode Island website

The Executive Office of Health and Human Services State of Rhode Island

Third Party Liability

Federal regulations require Medicaid to be the "payer of last resort".  This means that all third party insurance carriers, inculding Medicare and private health insurance carriers, must be billed before Medicaid processes the claim.  Additionally, Providers must report any payments from third parties on claims filed for Medicaid payment.

Third Party Insurance Codes

Carrier Codes  

Coverage Codes

Third Party Liability Information Card 

Third Party Liability Updates

Rite Share Billing
Rite Share is Rhode Island's Premium Assistance Program that provides help paying for an employer's health insurance plan.  The State will pay all or part of the cost for employee health insurance coverage.  Please review the Billing Guidance.

Coordination of Benefits – Bill Primary Insurance(s) Before Medicaid

As a reminder when billing claims for patients with dual/multiple coverage(s), Medicaid is legally the payer of last resort.
You must file claims with all commercial, private, or primary insurance plans before submitting them to Medicaid.
Required Action Steps:
 1. Verify Coverage: Check the patient's primary insurance status at every visit using the Healthcare Portal.
 2. Submit to Primary: Route the initial claim to the commercial or private carrier first.
 3. Await EOB: Wait until you receive the primary insurer's Explanation of Benefits (EOB).
    -Submit to Secondary: If the recipient has a secondary coverage, route the claim and primary EOB to that carrier.
 4. Bill Medicaid: Submit the remaining balance to Medicaid, attaching the primary/secondary EOB(s).
   -The EOB(s) must show the payment/processing date, the applicable payment amount and the claim reason codes.

Electronic Secondary  Billing for Medicare and Senior Replacement Plans
Please view billing instructions if using the Provider Electronic Solutions Software.  The appropriate Carrier Codes can be found in the table below.

Electronic Secondary Billing for Medicare and Senior Replacement Plans
To facilitate electronic billing and proper reimbursement for Medicare and Commercial Medicare Plans (Advantage/Replacement Plans) such as United Senior Care, Blue-Chip Medicare HMO, WellCare Advantage Plan the following fields are required:

  • Loop 2320 Other Subscriber Information SBR09 - Must contain MA or MB as appropriate for the claim filing indictor
  • Loop 2320 Claim Level Adjustments CAS segment - Must contain Deductible PR 1 or Coinsurance of PR 2
  • Loop 2320 Coordination of Benefits (COB) Payer Paid Amount – Must contain the Amount Paid (other insurance paid amount)
  • Loop 2330B Other Payer Name (Carrier Code) Segment NM109 Other Payer Primary Identifier – Must contain the appropriate carrier code, see below for a list:
MDA/MDB – Medicare 22A – Aetna Medicare Advantage Plan
06A – United Senior Care 24A – Connecticare Medicare Advantage Plan
08A – Healthfirst Medicare Advantage Plan 26A – Humana Medicare Advantage Plan
09A – HMO Blue of Massachusetts Advantage Plan 26B – Humana Medicare Advantage Dental Plan
12A – Blue Chip Medicare HMO 89A – Tufts Health Plan (PPO) Medicare Advantage Plan
18A – Wellcare Medicare Advantage Plan C01 – CarePlus Advantage Plan
19A – MMM Healthcare of Puerto Rico Advantage Plan C02 – Commonwealth Care Alliance, Inc. Medicare Advantage Plan
C10 - Neighborhood Dual Connect  

The RI EOHHS website uses CPT and ADA procedure codes and descriptions, which are copyrighted by the American Medical Association and American Dental Association.