Hospitals

Inpatient Facility
Outpatient Facility

Provider Representative
Care New England and Out of State Facilities:
 Karen Murphy   Tel. (401) 784-8004
                                                                                     email: [email protected]

Provider Representative
Lifespan and Independent Facilities:
Sandra Bates   Tel.(401) 784-8022                                                                                         email: [email protected]

Prior Authorization

Prior Authorization is not required if Medicaid is the second payer.

Inpatient Hospital stays are authorized by IPRO.  Please contact IPRO at 1-800-357-8417.

Out of State Hospital requests for inpatient or outpatient services require completion of a Prior Authorization request form and supporting clinical documentation.

Non-urgent requests should be mailed to:  Gainwell Technologies
P. O. Box 2010
Warwick, RI  02887-2010

Urgent only requests for both adults and children should be faxed to the following EOHHS staff:
Attn:  Heather Kinsey at (401) 462-6336  
For questions, contact Heather Kinsey at (401) 462-1796
 

Reference Guide

See the Institution for Mental Disease (IMD) Assessment Form  pertaining to RI Medicaid Program Institutions for Mental Diseases  210-RICR-10-00-7  (4/8/2020).

Updates

Effective with admission date July 1, 2010, Rhode Island Medicaid will be implementing All Patient Refined Diagnosis Related Groups (APR-DRGs) for pricing of inpatient claims. For additional information, please see:

Frequently Asked Questions  

RI DRG Calculator July 1, 2020 
RI DRG Calculator July 1, 2019 
RI DRG Calculator July 1, 2018   
RI DRG Calculator October 1, 2017  
RI DRG Calculator July 1, 2016  
RI DRG Calculator December 1, 2015
RI DRG Calculator July 1, 2012 
RI DRG Calculator July 1, 2011 
RI RRG Calculator July 1, 2010 

Effective October 1, 2009, Outpatient Hospital Facility claims with dates of service October 1, 2009 or greater will be subject to the new Ambulatory Payment Classification (APC) Fee Schedule.  For more additional information, please see:

DHS notification letter 
APC Fee Schedule 2020  
APC Fee Schedule  2019  
APC Status Codes 
Frequently Asked Questions 
Laboratory Procedure Codes  
Radiology Procedure Codes  

J Codes Requiring NDC

J Code Conversion Table