Neighborhood News
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Announcements
- Annual Provider Satisfaction Survey Starts in Early September
- Behavioral Health Webinars Scheduled for Summer 2025
- New Home Care Prior Authorization Forms Now Available
- Prior Authorization Continuity for Members Affected by Recent PCP Closures
- Telemedicine Policy Updates
- Updated Home Health Agency Payment Policy Now Available
Claims
Payment Policies
Pharmacy
- Commercial Pharmacy Benefit Update
- How to Bill 340B Appropriately
- Medicaid and Commercial Limited Speciality Pharmacy Network Coverage Update
- Medicaid Long Acting Injectable Antipsychotic Coding Update
- Opioid Prescribing and Alternative Therapies for Neighborhood INTEGRITY Members
- Pharmacy Benefit Medicaid Drug Rebate Program
- Prescription Drug Coverage in Assisted Living and Long-Term Care Facilities
- Specialty Medication Prior Authorization Criteria
Monthly Pharmacy Benefit Changes: On a monthly basis, Neighborhood places a list of formulary changes on its website for each line of business. For more information, please visit the Pharmacy Provider Resources webpage.
Quality Improvement
- Coding Best Practices: Kidney Health Evaluation for Patients with Diabetes (KED)
- Coding Best Practices: Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents (WCC)
- Coding for Eye Exams for Patients with Diabetes
- Improving Follow-Up Care for Children Prescribed ADHD Medications
- Statin Therapy for Patients with Diabetes
Reminders
- Claim Submission Reminders: Corrected and Duplicate Claims
- Efficient Use of the Peer-to-Peer Lines
- Keep Your Provider Information Up to Date
- LTSS Approval Required for Home Care Hours Above Preventive Level – INTEGRITY (MMP)
- LTSS Waiver Requirement for INTEGRITY (MMP) Members in Skilled Nursing Facilities
- Member Billing and Timely Claims Submission
- Rhode Island Medicaid Provider Screening
Risk Adjustment
The News and Updates section of the Neighborhood website is used to share important news and information including notifications on payment policies, operational issues, and more.