Rhode Island Medicaid

Please follow the Enrollment Instructions below to become an electronic submitter for Rhode Island Medicaid.

 

Required Documents for those applying for new Submitter IDs

The following documents are required enrollment documents that must be completed, signed and returned to the Medicaid office prior to initiation of electronic claims submission or inquiry.

 

1. Electronic Data Interchange Trading Partner Agreement

 

To obtain the forms above, please download them from:
http://www.dhs.ri.gov/Portals/0/Uploads/Documents/Public/tpa.pdf

 

We can now process 276/277 requests (claim status). If this is a transaction you would like to utilize please make sure to enroll with the payer.

 

Electronic Data Interchange Trading Partner Agreement

  • Please enter your Business or Provider name on the first line

  • On section 2.2, please enter your Name, Address, and Contact information.

  • Please Enter your NPI & MA Provider Number

  • On section 6.1 please Verify if your software Vendor is a Certified Vendor. If you use our software call us for that information

  • On Page 7 select 837 Professional or 837 Institutional, 999 Functional Acknowledgement, and 835 Remittance Advice

  • For Software, please enter the information for the software or vendor that creates your 837 files you need ClaimShuttle to transfer for you. If you have paid for our billing software please call our support line for our software information.

  • For Method of Transmission please write in “EDS Web portal”

  • Under the Guidelines section please enter the names and phone numbers of the main contacts for your office

  • Please complete “Article VIII…” with your NPI and Provider information.

  • Please sign the last page and mail this form to the address below

 

Submitting your Forms

It is recommended that you keep a copy of all the forms you will be submitting for your records. Mail the enrollment forms reflecting original signatures to:

 

HP Services, LLC
Attn: EDI Coordinator
PO Box 2010
Warwick, RI 02887-2010

 

It is very important that you complete and return the entire enrollment packet as described above. Incomplete packets will not be processed and will be returned to the submitter.

 

Waiting for a Response

Once the complete provider enrollment packet has been received, the documents will be processed. Processing will take approximately two weeks from the date of receipt. (Remember that mailing time can take as much as five days.)

 

After processing, a confirmation will be sent to you as notification to begin filing claims electronically. If neither notification, nor a returned enrollment packet is received after 2 weeks, please call EDI Coordinator Mary Jane Nardone at 401-784-8014.

Testing

Once you have received your Submitter ID and Password from Medicaid, please call the ClaimShuttle Support Team and set an appointment for a Mailbox setup and Test Transmission to Medicaid.

Please have 25 test claims ready for testing. Test files should consist of a variety of claims that represent the type of claims you will be submitting once production status is achieved. Test claims will not be processed for payment but will be validated against production files; therefore, they must contain valid patient procedure, diagnosis, and provider information.