Providers

Important Updates

Do Not Bill INTEGRITY for Duals Members for Medicare Cost Share

Neighborhood continues to identify instances in which INTEGRITY for Duals members are incorrectly being billed for Medicare cost-share amounts. As a reminder, INTEGRITY for Duals members with active Medicaid eligibility must NOT be billed or balance billed for Medicare cost-share amounts for covered services. This includes Medicare deductibles, copayments and coinsurance. For more info click here.

2027 Provider Training Now Live

Neighborhood Health Plan of Rhode Island (Neighborhood) has released its updated annual Provider Training for 2027. All contracted providers are required to complete the training and submit an attestation between October 1 and December 31, 2026 to remain compliant with Neighborhood’s annual training requirement. Only one authorized representative per provider group is required to attest.

Any training completed prior to October 1, 2026 does not satisfy the 2027 annual training requirement.

Providers may complete the training independently at their convenience or attend one of three live training webinars offered this fall.

Finding Prior Authorization Information Just Got Easier!

We’ve redesigned our Prior Authorization page to make it easier to find the information you need and understand the steps required to receive an authorization.

The new streamlined experience guides you through the prior authorization process step by step, provides easier access to key resources and features an improved Prior Authorization Search Tool with clearer search results and additional guidance when a procedure code isn’t found.

Explore the updated Prior Authorization page and see what’s new.

Important Reminders

Optum Claims Reminder

All behavioral health claims with dates of service prior to September 1, 2025 should have been submitted to Optum. Providers have until August 31, 2026 to contact Neighborhood regarding these claims. After August 31, 2026, Neighborhood will no longer review or consider requests related to claims submitted to Optum. For questions or assistance, please contact your Provider Relations Representative or email providercomms@nhpri.org.

Provider Screening Requirement

Make sure you complete and maintain Rhode Island Medicaid screening as mandated by the 21st Century Cures Act. It is the provider’s responsibility to ensure their individual and group NPI screening status does not expire, which could impact payment and/or participation status with Neighborhood. For instructions on how to maintain compliance, please refer to our screening and enrollment guidelines.

Important Updates

Important Reminders

News and Updates

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