Medical billing services in Rhode Island
Billing, coding, credentialing and A/R follow-up for providers in Rhode Island.
Billing in Rhode Island: what is different
Most Rhode Island Medicaid members are enrolled in managed care plans.
Key payers and contractors in Rhode Island
- Medicare Part A/B
- National Government Services, Jurisdiction JKPortal: NGSConnex
- Medicare DME
- Noridian, DME MAC Jurisdiction ADME supplier claims only · Portal: Noridian Medicare Portal (NMP)
- Medicaid
- Rhode Island Medicaid (RIte Care)
- Blue Cross Blue Shield
- Blue Cross & Blue Shield of Rhode Island
- Medicare Advantage
- UnitedHealthcare, Humana, Aetna, Wellcare, Blue plans and others, depending on the county
Contractor assignments and plan lists change. We confirm the current setup for your practice during onboarding.
How we work with Rhode Island providers
- Medicaid enrollment with the state, then credentialing with each managed care plan you need
- Medicare enrollment through PECOS and claims with National Government Services through NGSConnex
- Credentialing and contracting with commercial and Blue plans
- Eligibility checks that confirm each patient’s plan and assigned MCO before the visit
- Prior authorization tracking by plan
- Denial, appeal and A/R follow-up under each payer’s filing limits
Medical billing in Rhode Island: common questions
Do you bill Rhode Island Medicaid and its managed care plans?
Yes. We bill Rhode Island Medicaid fee-for-service claims and each Medicaid managed care plan, after confirming the patient’s assigned plan for the date of service.
Who processes Medicare claims in Rhode Island?
Medicare Part A and B claims in Rhode Island are processed by National Government Services (Jurisdiction JK), and we submit and track them through NGSConnex. DME supplier claims go to a different contractor, Noridian (DME MAC Jurisdiction A), through the Noridian Medicare Portal (NMP).
Can you credential new providers in Rhode Island?
Yes. We handle state Medicaid enrollment, Medicare enrollment, CAQH and credentialing with the commercial and managed care plans you need in Rhode Island.
Neighboring states and key payers
Get a free billing audit for your Rhode Island practice
Send a few details and we will set up a short call to review your claims, denials and A/R. No cost and no commitment.
We sign a Business Associate Agreement before we handle any patient data.