Providers may request to have an adjustment made to a previously processed claim for reasons such as, but not limited to, coordination of benefits or payment modifications and timely filing (TF) denials.
Request for a Single Claim Adjustment
Adjustment requests for singular claims can be submitted electronically via web-based electronic forms (eForm). Adjustment requests require the submission of a completed Adjustment Request eForm, applicable claim number, and Remittance Advice, Explanation of Benefits, and/or Coordination of Benefits documentation, as applicable.
Select a plan below to initiate the adjustment request process for a single claim:
- INTEGRITY (Medicare-Medicaid Plan) / Commercial Plans
- Medicaid: ACCESS (RIte Care) / TRUST(Rhody Health Partners)
Request for Multiple Claim Adjustments
For larger provider groups, it may be necessary to request an adjustment on multiple claims. Adjustment requests can be made for up to fifty claims via a Claim Adjustment Grid. Neighborhood uses a Claim Adjustment Grid to review the information submitted in each row and respond to each issue via the “Final Outcome” column of the grid. As of January 2022, all providers requesting an adjustment to multiple claims must use the electronic form (eForm) process outlined below.
Note: The Claim Adjustment Grid process is for adjustment requests only. Providers can use NaviNet to look-up the status of a claim.
Submitting a Claim Adjustment Grid via eForm
- Choose the appropriate link below to begin your request
- Instructions are on the grid, but please ensure all fields are complete, including the submitter’s information.
- Once completed click on the review button to confirm information before submitting.
- Click “submit” if all information is correct or click “previous” to make edits.
- You will receive a confirmation email immediately following your submission.
After your Claim Adjustment Grid submission
Within 48 hours, you will receive an email that includes a copy of your submission, as well as, a Neighborhood Issue ID for reference with an estimated completion date.
- If Neighborhood is unable to process a Claim Adjustment Grid, the submitter will be notified via email within 48 hours. The email will include a Neighborhood Issue ID for reference and the reason(s) for rejection (e.g., incomplete and/or missing data information, incorrect format). Submitters should address the rejection concerns and submit again via the process above.
Completed grids will be returned to the submitter via secure email with the “Final Outcome” column updated within 30 calendar days from the acknowledgement email date.
Questions and clarification
If you don’t receive an acknowledgment email within 48 hours or if your grid is not resolved within 30 days from acknowledgment, please email ClaimResubmission@nhpri.org and include the Neighborhood Issue ID (if received) for reference in the subject line.
For all other questions, please call Neighborhood Provider Services at 1-800-963-1001.