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.  Neighborhood created a Cross-Reference Guide that identifies the equivalent Plan ID for the Group Number displayed in NaviNet to assist users.  For additional help or information, contact Neighborhood Provider Services at 1-800-963-1001.

Claims Submission Information

Paper claims can be mailed to the following address:

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

For electronic submissions, use the proper payer ID for the applicable line of business:

  • Medicaid Claims Payer ID 05047
  • Exchange/Commercial and INTEGRITY (Medicare-Medicaid Plan) Claims Payer ID 96240

Neighborhood has partnered with ABILITY to offer our network providers a way to submit claims electronically – free of charge for all Neighborhood claims*. By registering with ABILITY (claims clearinghouse), you can increase your practice’s efficiency and get paid faster.   Sign-up today by sending the information below via secure email to: abilityinfo@nhpri.org

  • Name
  • Full Address, including City, State and Zip Code
  • Phone Number
  • NPI (group and/or rendering)
  • Tax ID

* ABILITY can be used by Neighborhood providers for other payers, however, there will be a charge assessed for those submissions.

For information and guidance on requesting an adjustment to a previously processed claim(s), please click here.

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

Participating Providers: Please consult Neighborhood’s 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