Claim Processing System Upgrade for Improved DRG Reimbursement

January 2022

Neighborhood Health Plan of Rhode Island (Neighborhood) is committed to investing in solutions that better support our customers and business.   As part of our pledge to provide excellent provider service, Neighborhood began updating our core administrative and claims processing system for our Medicaid line of business, HealthRules, over a year ago.   These incremental upgrades were performed to refine internal processes, as well as, improve the business experience for Neighborhood network providers.

  • In mid-March 2022, Neighborhood is expected to complete another HealthRules upgrade which includes an All Patient Refined Diagnosis Related Groups (APR DRG) update from Version 36 to Version 39.

This anticipated enhancement incorporates cloud-based technology, giving Neighborhood the most up-to-date information needed to process claims accurately and efficiently, specifically related to DRG reimbursement.   HealthRules cloud-based technology will ensure Neighborhood remains current with annual system updates to align with industry standard.  This upgrade will impact all providers submitting claims on behalf of Neighborhood Medicaid members.

Again, Neighborhood expects our system to be updated by March 14, 2022 and we will keep our network providers abreast of any changes to the target timeline.  If you have any questions, please call Neighborhood Provider Services at 1-800-963-1001.