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, 2015RI 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
