Coronavirus Update

COVID-19 Provider Guidance

Neighborhood is grateful to our network providers for the care and response provided to our members during the COVID-19 pandemic.  In an effort to assist you in working with Neighborhood during this evolving situation, we have compiled a list of frequently asked questions and answers regarding COVID-19.

Below is a list of frequently used payment policies during the COVID-19 pandemic.  Click here to view all current Neighborhood billing guidelines and payment polices.  Former versions of the temporary COVID-19 payment polices are listed in the “Archives.”

Throughout this challenging time, Neighborhood has worked closely with the Rhode Island Department of Health, the Rhode Island Office of the Health Insurance Commissioner (OHIC), the Executive Office of Health & Human Services, and other health experts to understand the impact to our members, providers, as well as, our own business. This page will be updated as more information becomes available.

Wellness Summit: Addressing Physician Burnout during the COVID Pandemic |  Click here to watch the June 15, 2021 event.  Presented in partnership with Providence Business News, this was the first summit of a two-part wellness series supporting health care professionals. The second summit is scheduled for September 9, 2021. To receive an invitation to this event and sign up for email communication from Neighborhood, click here.

Additional Resources

 

Last updated: Jul 28, 2021 @ 11:43 am

Previous Updates:  Mar 10, 2020 @ 4:46 pm; Mar 6, 2020 @ 5:08 pm

News and Updates

Recent News for Neighborhood Providers

CVS Caremark Transition

Optum Transition

CVS and Optum Transitoons CVS Caremark® and Optum® Transitions

To help our providers prepare for changes to management of behavioral health and pharmacy benefits effective January 1, 2019, please refer to these resources. This page will be updated with new information as it becomes available.

Forms

Prior Authorization Request Forms

New Guidance for Claim Adjustment Requests
Please visit Neighborhood’s new webpage on Claim Adjustments to view revised guidance on the Claim Adjustment Grid process. Improving this process for our providers is a Neighborhood priority this year.  The Claim Adjustments webpage is only the first step as Neighborhood aims to make doing business with us easier.

Clinical Medical Policies

The Medical Review staff of the Medical Management Department utilize clinical medical policies (CMPs) to guide decisions regarding Neighborhood’s Conditional Benefits.

Through collaboration with Neighborhood’s Associate Medical Director, and our specialty consultants, the policies are developed and/or revised following thorough review of current medical literature and standards of practice. To the extent possible, Neighborhood’s CMPs are developed according to evidence-based outcomes.

To view one of Neighborhood’s approved CMPs, please click the link below:

Claims and Eligibility Information

Neighborhood is contracted with NaviNet to provide online member benefit, eligibility, and claims status lookup. Both contracted and non-contracted (out-of-network) providers can use NaviNet.  Click here to access the NaviNet website.  For additional help or information, contact Neighborhood Provider Services at 1-800-963-1001.

Click here for a guide to assist NaviNet users to cross-reference Neighborhood Plan ID numbers with NaviNet Group ID Numbers.

Claims Submission Information

Electronic Claims:

Medicaid Claims Payer ID 05047

Exchange/Commercial and INTEGRITY (Medicare-Medicaid Plan) Claims Payer ID 96240

Paper Claims:

Neighborhood Health Plan of Rhode Island
P.O. Box 28259
Providence, RI  02908-3700

Each Neighborhood line of business has certain levels of appeal and submission timeframes, outlined in the Provider Appeal Process and Timelines reference table.

INTEGRITY Provider Appeal Rights

Par Providers: Please see your Provider Manual for Appeal Rights

Non-participating Providers:

If you disagree with the amount of the payment or denial for the service(s) rendered, you have the right to request a reconsideration or appeal. You must file your appeal within 60 days of the date on the remittance notification. To file an appeal, send a written appeal to Neighborhood Health Plan of Rhode Island Attn: Grievance and Appeals Coordinator 910 Douglas Pike Smithfield, RI 02917. Please supply additional written documentation with your appeal to include comments, clinical records, or other documentation that supports your appeal. We will review our initial decision and notify you in writing of the outcome of your appeal. We will respond to administrative appeals within 60 calendar days and medical necessity appeals within 30 calendar days of receipt. Please note if you choose to appeal, you must also submit a signed Waiver of Liability, which holds our member harmless regardless of the appeal outcome. Form can be found at:

https://www.cms.gov/Medicare/Appeals-and-Grievances/MMCAG/Downloads/Waiver-of-Liability-Notice.pdf