Medicaid Managed Care Organization Enrollment

The 21st Century Cures Act 114 P.L. 255 requires all Medicaid Managed Care network providers under all service delivery models, including OPR's, furnishing services to Medicaid beneficiaries regardless of specialty to be enrolled with or screened by the State Medicaid Agency or risk being removed for the Rhode Island Medicaid Managed Care Network.

Providers are not required to provide services to Fee for Service Medicaid beneficiaries, however before requesting enrollment from a Managed Care network you must be screened by the State Agency.

The application for enrollment/screening can be accessed directly on the RI Medicaid Healthcare Portal. Go to Provider Enrollment then select Enrollment Application.  Select MCO (Managed Care Organization) Provider in the Type of Provider Enrollment drop-down menu then indicate MCO affiliation.  Please note, it is of the utmost importance that you complete the entire screening application in full—incomplete applications could result in the loss of your RI MCO Medicaid billing privileges.  If a provider has been screened by Medicare then RI Medicaid will rely on Medicare's screening and the collection of the application fee but providers will need to complete the Disclosure statements for this screening.  Providers not screened by Medicare may be required to pay an application fee.

Existing MCO Only Providers

Existing providers will be notified in writing by each Medicaid Managed Care network when it is time for your provider type to complete the screening.

Existing providers should continue to provide services to RI Medicaid managed care members as their Enrollment Application is processed. The applying Provider’s participation will not be terminated during this time-period. However, continued noncompliance with the Enrollment Mandate will result in the future termination of your contract as determined by the Office of Health and Human Services.

If you have questions or concerns about the screening process that are not answered by the Provider Enrollment User Guide or the FAQ's then, please contact our Customer Service Help Desk at (401) 784-8100 for in-state and long-distance calls or 800-964-6211 for in-state toll calls.
You may also email rienrollment@gainwelltechnologies.com

Contact Information for the Medicaid Managed Care Networks

  • 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.