Providers may experience extended processing times for INTEGRITY for Duals and Dual CONNECT claims as a result of the product transition. During this transition period, claims may display a pended status in NaviNet while undergoing quality review.
Please note that amounts displayed for pended claims in NaviNet are not final. Once claims are finalized, NaviNet will reflect the same information that appears on the Remittance Advice (RA). Providers should reference the RA as the source of truth for finalized account posting information.
Neighborhood aims to have all claims adjudicated within applicable contractual timeframes. Thank you for your patience as we ensure a successful transition.
Neighborhood has identified an issue with the distribution of electronic remittance advices (ERAs) for recent INTEGRITY for Duals And Dual CONNECT claims. The issue was been resolved and all missing ERAs from prior pay cycles will be issued this week. ERAs for this week’s payment cycle for INTEGRITY for Duals and Dual CONNECT claims will be generated and distributed as normal. We apologize for the inconvenience and appreciate your patience as we worked to resolve this issue.
Neighborhood Health Plan of Rhode Island is informing providers of a temporary issue affecting machine-readable ASCX12 835 remittance advice (RA) files for Neighborhood INTEGRITY for Duals (HMO DSNP) and Dual CONNECT (HMO D-SNP) claims.
Due to an issue, 835 files for D-SNP claims will not be generated. Work is underway to resolve the issue, which is expected to take up to eight weeks.
Providers who currently receive only an 835 file can complete the Electronic Payment and Remittance Advice Application to receive electronic or paper remittance advices. Completed forms should be emailed to eftproviders@nhpri.org.
We will share updates as more definitive information becomes available. Thank you for your patience and understanding as we work to resolve this issue. Read more here.
Long-Term Services and Supports
Long-Term Services and Supports (LTSS) is a benefit available to members with chronic illnesses or disabilities who need a certain level of care and meet the eligibility criteria. The type of services a member receives depends on the level of care needs.
Lines of Business
- Commercial: Does not have an LTSS benefit.
- Medicaid: Members who qualify for an LTSS waiver are managed out-of-plan by Medicaid fee-for-service (FFS). Authorizations and claims for these services are processed through FFS.
- INTEGRITY for Duals: Both Medicare and Medicaid LTSS services are managed by Neighborhood.
- Dual CONNECT: Neighborhood manages only the Medicare benefits. LTSS Medicaid benefits are managed directly by the state. Providers must obtain authorization and bill the state for Medicaid-covered services.
LTSS Services
LTSS services include, but are not limited to:
Resources
Clinical Medical Policies
News and Updates
Below is a list of all LTSS-related news items, for more updates please go to our News and Updates page.
Neighborhood Provider Resources
Neighborhood LTSS Forms
EOHHS Resources