Provider Enrollment Provider Participation To participate in the RI Medicaid, providers must be located and performing services in Rhode Island or in a border community . Consideration will be given to out-of-state providers if the covered service is not available in Rhode Island, the recipient is currently residing in another state or if the covered service was performed as an emergency service while the recipient was traveling through another state. Effective Date of Enrollment Retroactive enrollment is limited to the first day of the month in which the application is approved. For specific enrollment information, refer to the Provider Participation section in the Provider Manual for your provider type. Click here for Provider Manuals. Instructions for Enrollment as a Medicaid Provider Provider Enrollment in RI Medicaid has changed! Beginning July 30, 2015, provider enrollment for the RI Medicaid Program is completed electronically through the Enrollment Portal, in the Healthcare Portal. Paper applications are no longer accepted except for attending physicians being added to an existing group. It is important to note the following: Instructions for completing the electronic application are accessible on the homepage of the Healthcare Portal. Attending providers being added to a group will continue to submit a paper application found below. Effective October 1, 2015, Ordering, Prescribing and Referring (OPR) providers must be enrolled in the RI Medicaid program to order, prescribe, or refer items or services for Medicaid beneficiaries. For more information on the claim types impacted or claims processing information, please review the Frequently Asked Questions document. If you have any questions, please contact the Customer Service Help Desk at (401) 784-8100. Enrolling as a Medicaid Managed Care Organization Provider: Providers interested in enrolling with Medicaid Managed Care Organizations (MCOs) are advised to contact MCOs directly via links below. All questions regarding enrollment and/or credentialling should be directed to MCOs. Neighborhood Health Plan of Rhode Island (NHPRI) - https://www.nhpri.org/providers/join-our-network/ [nhpri.org] Tufts Health Public Plans (THPP) - Provider Services call center at 844.301.4093 can answer any questions, direct providers to the appropriate forms to initiate the credentialing process and provide status on previously submitted requests. The Provider page on Tufts Health Plan website, https://tuftshealthplan.com/provider/home [tuftshealthplan.com], contains hyperlinks to the required forms and provides an email address and fax number for submission of completed forms. United Healthcare (UHC) - https://www.uhcprovider.com/en/resource-library/Join-Our-Network.html?CID=none [uhcprovider.com] Adding a Provider, RIte Share, and LEA Providers New Provider Joining an Existing GroupRIteShare Providers Local Education Agency (LEA) Providers Enrolling as a Trading Partner Once you are enrolled as a provider in RI Medicaid, you must apply for a Trading Partner ID to access eligibility, claim status and remittance advice. Applicants may access the electronic enrollment process by visiting the RI Healthcare Portal . All existing Trading Partners are required to register in the Healthcare Portal. Instructions are found on the Healthcare Portal page. Revalidation of RI Medicaid Enrollment Providers are notified by mail when they are required to revalidate enrollment with RI Medicaid. Notices are also published in the monthly Provider Update. Click here for instructions for revalidation Supplemental Application Documentation for Provider Revalidation Application Fees for Providers Providers who are applying for either enrollment in RI Medicaid or revalidation of RI Medicaid enrollment may be required to pay an application fee. Click here for more information Additional Forms Electronic Funds Transfer (Mandatory)W9 Form and Instructions RI Medicaid Disclosure Questions Additional Federally Required Disclosure Information Provider Change of Information Form Home Care Transportation Certification (Mandatory for Home Care Agencies)Home Care Transportation Policy Send forms to: Gainwell Technologies/Provider Enrollment P.O. Box 2010 Warwick, Rhode Island 02887-2010 Need help with the application process? Please call: Dianne Folco (401) 784-3801 LINKS For additional information for new RI Medicaid Providers, view the Welcome New Provider presentation. Are you using Electronic Billing? Billing software is available at no cost to RI Medicaid Providers. Download a copy of our proprietary software Provider Electronic Solutions (PES) Software. We provide training and support to get you started. Want to check your Claims or Prior Authorization status online? Please visit the Healthcare Portal page for more information or to apply for a Trading Partner number.