Home And Community Based Services

Medical Coverage Guidelines

Please note that coverage guidelines and procedures are subject to change. Refer to the monthly Provider Update for more information.

Home and Community Based Services Provider Reference Manual  

Federal Rule

Home Care Services Rates (effective 7/1/2019)  

Updates

LTSS Providers

Effective 9/13/22 you will notice that two of the waiver/program names have changed in the Healthcare Portal when you are checking for member eligibility.  The member is still eligible for the same services that they were eligible for under their prior waiver/program name.  Please note that only the names of the programs have changed.   

Core Community Services  has changed to “LTSS – HCBS Services”

DEA Community Services has changed to “OHA Community Services”

Additionally, recipients can now simultaneously be enrolled in the LTSS-HCBS (formerly core) and one of the following waiver programs:

OHA community waiver program

Shared Living

Habilitation Community Service

Habilitation Group Home Service

Claim Preparation Instructions

Waiver Form Filing Instructions 
Waiver Services - Waiver/Rehab Claim Form 

CMS 1500 Form Filing Instructions 
Waiver Services - CMS 1500 Claim Form 

Error Status Codes

ESC Code List (English) 

Explanation of Benefits (EOB) Codes
 

EOB Codes and Messages List (English) 
EOB Codes and Messages List (Spanish)

Appendix - Third Party Liability Carrier and Coverage Codes

Third Party Liability Carrier and Coverage Codes

For specific questions you may contact the Customer Service Help Desk at (401) 784-8100 for In-state and long distance callers, or 1-800-964-6211 for In-state toll callers and border communities.