July 2021

Neighborhood Health Plan of Rhode Island (Neighborhood) has recently revised its Obstetrical Services and Physician Services payment policies.  Please see below for details.

Obstetrical Services – Effective August 1, 2021

• Applicable to all lines of business (Medicaid, Commercial/Exchange, and INTEGRITY).
• Includes revised billing guidelines for multiple births and guidelines for obstetrical ultrasounds.
• Replaces both Neighborhood’s Obstetrical Billing Guidelines published on September 1, 2010 and Neighborhood’s Obstetrical Ultrasounds Clinical Medical Policy.

The revised payment policy for Obstetrical Services will be published on the Billing Guidelines and Payment Policies webpage prior to August 1, 2021.

Physician Services – Effective May 1, 2021

• Applicable to all lines of business (Medicaid, Commercial/Exchange, and INTEGRITY).
• The Physician Services Payment Policy includes billing guidelines for routine physical examinations and periodic check-ups, sick visits, specialty care office visits, observation care, inpatient care, and home visits.
• Replaces any guidance that was previously published under the following separate and distinct documentation:
  • Emergency Department Services Evaluation and Management Codes
  • Evaluation and Management Codes
  • New Versus Established Patient Billing Guidelines
  • Pediatric Critical Care Transport
  • Critical Care Billing Guidelines
  • Hospital Inpatient Billing Guidelines
  • Inpatient Neonatal and Pediatric Critical Care Coverage Summary
  • Observation Evaluation and Management Billing Guidelines
  • Preventative Medicine Billing Guidelines
  • Special Services Procedures and Reports Billing Guidelines

The above documents can be viewed on the Billing Guidelines and Payment Policies Archive webpage.  This new webpage hosts former versions of Neighborhood’s billing guidelines and payment policies.  All current payment policies are posted on the Billing Guidelines and Payment Policies section of the Neighborhood website.