Behavioral Health

• What is changing about how Neighborhood is managing behavioral health services?

As of September 1, 2025, Neighborhood has ended its relationship with Optum and begun to directly manage behavioral health services.

• Why is Neighborhood changing how it manages behavioral health services?

Neighborhood is committed to providing the best care and service possible to members. By managing behavioral health services, Neighborhood creates additional opportunities for integration between medical and behavioral providers.

• Where should members go if they have questions about how Neighborhood manages behavioral health services?

Members should call Member Services at 1-855-321-9244.

• Will behavioral health member benefits change?

There will be no changes to member behavioral health benefits.

• Will behavioral health services require a referral?

Neighborhood does not require referrals to access behavioral health services.

• Will behavioral health services require a prior authorization?

The only services that require prior authorization are non-covered and out-of-network services.

• How do providers become contracted with Neighborhood?

To join the Neighborhood network, behavioral health providers must submit an application through the Join Our Network Page. That application will start the contracting and credentialing processes.

• How do providers know if they are officially contracted with Neighborhood?

Once providers receive their counter-executed contract from Neighborhood, the contracting process is complete. If providers are unsure of your status, please email bhcontracting@nhpri.org to request an update.

• For providers currently seeing Neighborhood members through a contract with Optum but who have chosen not to contract with Neighborhood, what steps are necessary to continue providing care for these patients?

Members have a continuity of care period enabling them to continue seeing a non-contracted provider for a specified period of time. Providers who continue to treat members while they are not contracted with Neighborhood may be subject to applicable non-participating provider requirements. To ensure providers can continue providing care to their patients, they should contract directly with Neighborhood.

• If a practitioner joins a provider group after the contracting process is completed, what do providers need to do?

Providers should complete the following form to add a new provider to a practice/group that is currently contracted with Neighborhood.

• Once providers become contracted with Neighborhood, how do they receive training about doing business with Neighborhood?

Providers will receive a welcome letter with information about upcoming provider orientation sessions and training materials. Neighborhood will ensure providers have all the resources necessary to care for our members.

• What is the credentialing process for existing providers in Optum’s network who are now contracted with Neighborhood?

Providers credentialed through Optum can continue to treat Neighborhood members while undergoing Neighborhood’s credentialing process if they have completed an application and signed a contract with Neighborhood. While the Neighborhood contract will be effective on September 1, 2025, providers can continue to see members while the credentialing is in process which may take up until February 28, 2026.

• What is the credentialing process for new providers (not currently in Optum’s network)?

In order to participate with Neighborhood, providers not currently in Optum’s network must complete an application, sign a contract, and be approved by Neighborhood’s Credentialing Committee. To initiate the process, please go to Neighborhood’s Join Our Network page. Please be sure to complete the application as soon as possible, as the credentialing process may take up to 45 days.

The process includes validation of provider training, licensure, and/or certification to provide services in the specialty of practice.

Please refer to Section 9, Credentialing and Standards of Care of the Provider Manual, for the definition of a completed application as well as additional details of the credentialing process.

• Which providers need to be credentialed?

Physicians, doctoral, master’s level and other types of professional providers that are certified
and licensed to practice independently by the state:

• • Psychiatrist (MD)
  • Psychologist (PhD, PsyD, EdD)
  • Clinical Nurse Specialist (CNS)
  • Nurse Practitioner-Behavioral Health
  • Physician Assistant – Behavioral Health*
  • Licensed Applied Behavioral Analyst (LBA)
  • Licensed Chemical Dependency Professionals (LCDP)
  • Licensed Independent Clinical Social Worker (LICSW)
  • Licensed Mental Health Counselors (LMHC)
  • Licensed Marriage and Family Therapy (LMFT)

* Physician Assistants are credentialed to provide services in either behavioral health or medical
setting (not to practice in both settings simultaneously).

The physician assistant must provide name of collaborating physician when not practicing within a group. The collaborating physician must be a in network BH provider.

• Do providers under supervisory council need to be credentialed?

Yes, they both need to be credentialed and screened. Licensed providers who are not yet independently licensed (e.g., LCSWs or LMHC-a) working toward independent licensure may render services under supervision of an independently licensed clinician through supervisory billing.

• Does the provider’s Council for Affordable Quality Healthcare (CAQH) status need to be current to credential with Neighborhood?

CAQH status must be current when the credentialing decision is rendered. Neighborhood uses the CAQH application to credential providers.

• How will reimbursement work throughout the transition?

Providers will be reimbursed as per their Optum agreement through August 31, 2025. Effective September 1, 2025, providers will be reimbursed as per their Neighborhood agreement.

• How will providers bill for behavioral health services provided to members prior to September 1, 2025?

Optum will continue to support Neighborhood with behavioral health services for all dates of service through August 31, 2025.

To submit claims for services provided before September 1, providers should use the “Member ID Search” tab on the “Find Member Eligibility and Benefits” page of Optum’s Provider Express site. The default “My Patients” tab will no longer work, as members are no longer eligible and will not appear in the list.

When using the “Member ID Search” tab, providers should enter the member’s information and the date of service in the “Date to Check Eligibility” field to proceed with claim submission.

For questions regarding services provided prior to September 1, providers can contact Optum by visiting the Provider Express website or calling Optum Provider Services at 1-877-614-0484.

• How should I enter the member ID when submitting claims or checking eligibility?

Enter the member’s identification number exactly as it appears on the member’s ID card. Be sure to include the entire numerical sequence without truncating or cutting off any digits. Claims submitted with incomplete or incorrectly formatted member IDs will be rejected or denied.

• How should I enter my TIN when submitting claims to Neighborhood Health Plan of Rhode Island?

When submitting claims, behavioral health providers must enter the Taxpayer Identification Number (TIN) exactly as it appears on the W-9 submitted during onboarding.

• • If your W-9 lists a Social Security Number (SSN) as your TIN, use the SY qualifier.
  • If your W-9 lists an Employer Identification Number (EIN) as your TIN, use the EI qualifier.

Using the wrong qualifier may result in your claim being denied or rejected, so it’s important to double-check that both the TIN and qualifier match your W-9.

• How do providers receive reimbursement through Neighborhood?

Providers enrolled with an electronic funds transfer (EFT) will be paid electronically.

• How can providers receive electronic remittance advices (ERAs)?

Providers will need to complete Neighborhood’s Electronic Payment and Remittance Advice Application. The processing of the application can take up to eight weeks. Remittances are available in two formats: PDF (sent via secure email) or machine-readable ASC X12 835 (retrieved through ftp/sftp).

• How often does Neighborhood’s pay cycle run?

Neighborhood’s pay cycle runs once a week. Providers will receive two separate payments, one for Medicaid and Commercial claims, and one for INTEGRITY (MMP) claims. Clean claims will process within thirty (30) days of receipt.

• When should providers receive their ERAs?

You can expect to receive your ERA or 835 by Friday. If you do not receive your ERA or 835 by Friday, please fill out this form.

• Will the explanation of payment/remittance advice (EOP/RA) include both behavioral health and medical claims?

Yes. If the provider renders both types of services, they will receive an EOP/RA which includes both behavioral health and medical claims (i.e., all finalized claims within a payment cycle).

• How do providers check eligibility and claim status ?

We strongly encourage all behavioral health providers who have completed the contracting process to register for a NaviNet account to ensure you can check eligibility and claims. If you’ve registered for an account but haven’t received confirmation that it’s active within 5–7 business days, please reach out directly to NaviNet’s online support or call them at 888-482-8057.

• What are the timely filing limits with Neighborhood?

Complete claims must be received by Neighborhood within one hundred eighty (180) days from the date of service.

• How should we bill for claims for providers under the supervisory protocol?

Claims should list the supervised individual as the rendering provider, and the independently licensed supervisor as the billing provider.

• Do we have to fill in the rendering provider field?

Yes, providers must fill in the rendering provider field, or the claim will be denied. It cannot be left blank.

• What Payer ID will behavioral health providers use to bill Neighborhood?

Payer ID’s are determined by the member’s line of business, not by specialty. All contracted providers use the following Payer ID’s:

• • Medicaid and Commercial Claims: 05047
  • INTEGRITY (MMP) Claims: 96240
    

• How can providers request a copy of Neighborhood’s fee schedule?

Providers can request fee schedules by emailing bhcontracting@nhpri.org.

• What are Neighborhood’s claim submission standards?

Claims that do not require an attachment must be filed electronically. All Commercial and Medicaid
coordination of benefit (COB) claims, also known as secondary claims, must also be submitted
electronically.

Claims with any type of attachment, including, but not limited to the following, must be submitted in paper form:

• • Medical records
  • Single case agreements
• How does Neighborhood accept electronic claims?

Neighborhood has partnered with claims clearinghouses(Change Healthcare, Inovalon [formerly known as ABILITY], Waystar, Healthcare Revenue Cycle Solutions [SSI] and Claim.MD.)  to offer providers a way to submit all Neighborhood claims electronically.

Please make sure you are connected to one of the above clearinghouses or a billing system that connects through these partners.

If you use a clearinghouse or billing system not listed above, please check with them to confirm if they partner with one of Neighborhood’s approved clearinghouses. If you don’t currently use a clearinghouse or are only submitting claims through Optum’s Provider Express, email providercomms@nhpri.org for assistance.

All claims must be submitted electronically including Commercial and Medicaid Coordination of Benefits (COB) claims. Exceptions apply only to cases requiring attachments, such as, but not limited to, medical notes or records.

• How should providers bill for weekly procedures during the transition period?

For services billed in weekly units that begin in August and extend into September, providers should bill Optum using a date of service of August 31 with one unit. This one unit will cover services provided during the first week of September. Providers should not unbundle or separately bill Neighborhood for any additional services during that first week.

• How should providers bill for a member who is still in an inpatient stay on September 1, 2025?
  
  If providers are billing interim claims to Optum for a member who remains in an inpatient stay as of September 1, 2025, you must use the “first subsequent claim” Type of Bill code (112) on your first claim submitted to Neighborhood. This allows Neighborhood to correctly process the entire inpatient stay. The admission and patient information should remain consistent with what was submitted to Optum. This requirement applies only to the Type of Bill code. Use the following codes as appropriate:
• 112 – Interim, First Claim (use for the first claim submitted to Neighborhood)
• 113 – Interim, Continuing Claims
• 114 – Interim, Last Claim

• Can I submit claims through NaviNet?

No. Claims must be submitted electronically through one of the four clearinghouses listed above.

• Can providers who manage multiple behavioral health practices with different Tax IDs, access them all through one Navinet account?

Third-party administrators will need to register a NaviNet account as an Authorized Third Party. During registration, providers can list the Tax IDs you work with and upload the required Third-Party Authorization form. Once approved, providers will be able to manage multiple practices under a single account.