Upon enrollment, every Neighborhood Health Plan of Rhode Island (Neighborhood) member is issued an Neighborhood identification (ID) card, which specifies the member’s nine digit identification number, member’s date of birth, member’s name, group number, assigned participating provider group name and phone number.  Members are advised and expected to carry their Neighborhood ID card at all times and to call their primary care practitioner before seeking services, except in cases of life-threatening emergencies.  A sample of Neighborhood’s member card is shown below. 

Neighborhood members may select a Participating Provider Group (PPG).  This site serves as their primary care home.  Members select or are assigned a Primary Care Practitioner (PCP) who coordinates their health care needs.

Below are the RIte Care group numbers that your office may see on members’ identification cards.

1100 RIte Care
1200 RIte Care (copayment)
1300 RIte Care (premium billing)
1400 RIte Care Extended Family Planning (EFP)
1450 Buy-in Extended Family Planning (EFP)
1550 Buy-in (Pregnancy plus two months postpartum)
2100 Day care providers
5100 Substitute Care
5210 Children with Special Healthcare Needs (SSI)
5211 Children with Special Healthcare Needs Substitute Care (SSI)
5220 CSN – Katie Beckett Provisions
5230 CSN – Adopted members

Eligibility Verification

All providers should verify a member’s eligibility when providing services to a member (s) who presents an Neighborhood identification card.  Primary care practitioners must also verify that the member is assigned to the provider group and one of the group’s participating primary care practitioners in order to receive reimbursement for services rendered.  Neighborhood encourages our primary care providers to verify member site assignment even if your practice is listed on the member’s identification card.

How to Verify Member Eligibility

• Eligibility for RIte Care members may be verified through the State’s RIte Care Eligibility Verification Line at (401) 784-8100.
• Participating Provider Groups may also verify a member’s eligibility and/or PCP assignment by utilizing Neighborhood’s automated Interactive Voice Response (IVR) System, which may be reached by calling (401) 459-6610.  If you would like to be set up to use the IVR System, please contact the Provider Relations Team at (401) 459-6030.
• Participating Providers may also contact Neighborhood’s Member Services Department to verify member eligibility and/or PCP assignment at 1-800-459-6019.

Member Site Change Requests

If upon verifying member eligibility and site assignment, your office learns that an eligible member is assigned to another primary care site, please have the member contact the Member Services Department at 1-800-459-6019 or complete and sign the Member Site Change Request Form in Section 12.

Providers have five (5) business days from the date of service to fax the Member Site Change Request Form to Neighborhood at  (401) 459-6021. Site changes faxed beyond five (5) business days will be effective on the date the information was faxed.  Please note: this form must be signed by the member or member’s parent/head of household in order to be processed.

Important Note:  The member or member’s parent/head of household must sign this form in order for the site change to be processed.  Please confirm and include the member’s correct home address and telephone number on the form; this will enable us to expedite the site change request in a more timely manner.

Member Co-Payments

Neighborhood Health Plan of Rhode Island (Neighborhood) provides health insurance coverage to people participating in the state’s RIte Care program.  Some Neighborhood members have limited benefit packages and/or may be required to pay a co-payment for certain services.  When applicable, co-payment information is indicated on the member’s Neighborhood ID card directly on the front of the member ID card.  There are three types of possible co-payments that will be shown on the Neighborhood ID card:

1. Office Visit (OV)
2. Pharmacy (RX)
3. Emergency Room (ER)

Co-payments should be collected from Neighborhood members at the time of service.   In the event a member does not bring his or her Neighborhood ID card and services are rendered, please contact Neighborhood’s Member Services Department to obtain co-payment information and to verify member eligibility at 1-800-459-6019.