Provider Frequently Asked Questions (FAQ)

Medical Review FAQs
Authorization Quick Reference Guide 

1. How do I verify eligibility?

It is important to verify that a patient is a current member of Neighborhood Health Plan of Rhode Island (Neighborhood) and verify the assigned Primary Care Provider (PCP) at the beginning of each and every visit.  Request the patient’s Neighborhood card and verify coverage by calling one of the following telephone numbers:

Neighborhood Customer Service at 1-800-459-6019 or 1-800-963-1001. Representatives are available Monday-Friday, 8:30 am to 5:00 pm.

Interactive Voice Response (IVR), the Automated Support System, at 1-401-459-6610 or 1-866 646-3111, for in-state long distance, and follow the voice prompts, available 24 hours a day. 

If a patient is not a current member of Neighborhood, you may call:

RIte Care Infoline at 1-401-462-5300, Monday-Friday, 9:00 am to 3:30 pm, to request an application or to speak to a RIte Care Representative

EDS (RI Medical Assistance Program) Infoline at 1-401-784-8100, Monday-Friday, 8:00 am to 5:00 pm, to verify Medicaid eligibility  

2. I saw a patient that was not assigned to me, what should I do?

If upon verifying eligibility and site assignment, your office learns that an eligible member is assigned to another primary care site, please complete a Member Site Change Request Form and have the member (or member’s parent/head of household) sign the completed form. A copy of the Member Site Change Request Form is located in Section 12, Provider Forms, of the Provider Manual, and located on the website at Provider Forms. The completed and signed form should be faxed to Neighborhood Health Plan of Rhode Island (Neighborhood) at 401 459-6021. 

Or you may have the member (or member’s parent/head of household) contact Neighborhood Customer Service at 1-800-459-6019. 

Providers have five (5) business days from the date of service to fax the Member Site Change Request Form to Neighborhood.

3. How can I get a behavioral health referral for one of my patients?

Neighborhood contracts with Beacon Health Strategies LLC (Beacon) to coordinate and manage our member’s behavioral health care (mental health and substance abuse care). Neighborhood does not require any type of prior authorization for the first twelve (12) outpatient visits with a behavioral health provider. The primary care practitioner, other professionals working with the member, the member or a family member, may simply refer a member to a participating Neighborhood/Beacon behavioral health care provider without first calling Beacon. 

If you need assistance identifying or contacting a clinically appropriate behavioral health provider, please call Beacon’s Call Center at 1-800-215-0058. 

4. How do I add a new provider?

Please complete the New Practitioner Notification Form located in Section 12, Provider Forms, of the Provider Manual, and located on the website at Provider Forms, and fax it to the Delivery System Development department at 1-401-459-6066. 

You may contact the Delivery System Development Customer Service Representative at 1-401-459-6030 or contact your Provider Relations Representative for assistance. 

5. How do I change my Tax ID?

Please complete the Changes to Billing Address/Tax Identification Number Notification Form located in Section 12, Provider Forms, of the Provider Manual, and located on the website at Provider Forms, and fax it to the Delivery System Development department at 1-401-459-6066. 

You may contact the Delivery System Development Customer Service Representative at 1-401-459-6030 or contact your Provider Relations Representative for assistance. 

6. How do I change/add an address?

Please complete the Changes to Billing Address/Tax Identification Number Notification Form located in Section 12, Provider Forms, of the Provider Manual, and located on the website at Provider Forms, and fax it to the Delivery System Development department at 1-401-459-6066. 

You may contact the Delivery System Development Customer Service Representative at 1-401-459-6030 or contact your Provider Relations Representative for assistance. 

7. How long does it take to be credentialed?

The Delivery System Development Credentialing staff work diligently to process practitioner applications while ensuring the quality of our network by carefully reviewing credentials. Neighborhood has up to 180 days from the date a complete application is received to present a complete practitioner file to the Clinical Affairs Committee for review and recommendation to the Board of Directors for approval. While 180 days is the credentialing timeframe, the majority of applications are processed in less than 180 days.  

In order to facilitate the credentialing process, please submit a complete practitioner application to Neighborhood. For more information regarding the credentialing process, please see Section 11, Practitioner Standards, of the Provider Manual, or call the Delivery System Development department at 1-401-459-6030.