This webpage lists all former available versions of Neighborhood Health Plan of Rhode Island payment policies. Active current payment policies are available on the Billing Guidelines and Payment Policies webpage. Other documents listed below, such as coverage summaries and billing guidelines, are no longer maintained. Information regarding covered benefits and services can be found in the applicable Member Handbook or Certificate of Coverage.
A
- Adult Day Health Services Payment Policy – Archive 1 (Effective 9/01/2013 through 9/13/2020)
- Adult Day Health Services Payment Policy – Archive 2 (Effective 9/14/2020 through 9/28/2021)
- Annual GYN Exams CHC Billing Guidelines (Effective 9/1/2013 through 5/01/22; Replaced with Physician Services Payment Policy, effective May 2, 2022)
- Assisted Living Payment Policy (Effective 3/01/2018 through 3/15/2022)
B
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C
- Children’s Care Services Benefit Coverage Summary (Effective 9/24/2012 through 11/30/2021; Replaced with Children’s Care Services Payment Policy on 12/01/2021)
- Children’s Care Services Payment Policy (Effective 12/01/2021 through 12/02/2021)
- Complementary and Alternative Medicine (CAM) Services Payment Policy – Archive 1 (Effective 7/01/2018 through 9/28/2021)
- Complementary and Alternative Medicine (CAM) Services Payment Policy – Archive 2 (Effective 9/29/2021 through 11/01/2021)
- COVID-19 Vaccine Payment Policy – Archive 1 (Effective 12/11/2020 through 3/02/2021)
- COVID-19 Vaccine Payment Policy – Archive 2 (Effective 3/03/2021 through 6/14/2021)
- COVID-19 Vaccine Payment Policy – Archive 3 (Effective 6/15/2021 through 8/16/2021)
- COVID-19 Vaccine Payment Policy – Archive 4 (Effective 8/17/2021 through 9/26/2021)
- COVID-19 Vaccine Payment Policy – Archive 5 (Effective 9/27/2021 through 11/11/2021; Replaced with Immunization and Vaccine Payment Policy, effective 11/12/2021)
- Critical Care Billing Guidelines (Effective 9/01/2010 through 4/30/2021; Replaced with Physician Services Payment Policy on 5/01/2021)
D
- Date Range Outpatient Billing Guidelines (Effective 9/01/2011 through 9/30/2021)
- Diabetes Prevention Program Coverage Summary and Payment Policy (Effective 4/01/2018 through 5/24/2021)
- Dialysis Coverage Summary (Effective 10/03/2013 through 9/30/2021)
- Digestive Coverage Summary (Effective 4/04/2012 through 9/30/2021)
E
- Ear Coverage Summary (Effective 8/23/2012 through 9/30/2021)
- EKG Interpretation and Report with Surgeon Billing Guidelines (Effective 9/01/2013 through 9/30/2021)
- Emergency Department Services Evaluation and Management Codes (Effective 9/01/2010 through 4/30/2021; Replaced with Physician Services Payment Policy on 5/01/2021)
- Evaluation and Management Codes (Effective 9/01/2010 through 4/30/2021; Replaced with Physician Services Payment Policy on 5/01/2021)
- Exploratory Surgery Billing Guidelines (Effective 9/01/2013 through 9/30/2021)
- Extended Family Planning (EFP) Services Payment Policy – Archive 1 (Effective 12/11/2019 through 9/27/2020)
- Extended Family Planning Payment Policy – Archive 2 (Effective 9/28/2020 through 9/28/2021)
F
- From and To Date Range Billing Guidelines (Effective 09/01/2013 through 9/30/2021)
G
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H
- Hemic and Lymphatic Coverage Summary (Effective 10/03/2013 through 9/30/2021)
- Home Health Care Services Payment Policy – Archive (Effective 4/08/2020 through 11/02/2020)
- Hospital Inpatient Billing Guidelines (Effective 9/01/2010 through 4/30/2021; Replaced with Physician Services Payment Policy on 5/01/2021)
I
- Immunization and Vaccine Payment Policy (Effective May 25, 2021 through 11/01/2021)
- Implants Coverage Summary (Effective 10/03/2013 through 9/30/2021)
- In Lieu of Services Payment Policy – Archive 1 (Effective 7/16/20 through 9/28/2021)
- In Lieu of Services Payment Policy – Archive 2 (Effective 9/29/2021 through 11/01/2021)
- Inpatient Neonatal and Pediatric Critical Care Coverage Summary (Effective 9/01/2010 through 4/30/2021; Replaced with Physician Services Payment Policy on 5/01/2021)
- Integumentary and Musculoskeletal Coverage Summary (Effective 3/09/2011 through 9/30/2021)
J
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K
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L
- Laboratory Coverage Summary (Effective 7/25/2011 through 9/30/2021)
- Labor Evaluation Billing Guidelines (Effective 9/01/2013 through 9/30/2021)
- Lesion Excision Surgery Billing Guidelines (Effective 9/01/2013 through 9/30/2021)
M
- Male Genital and Urinary System Coverage Summary (Effective 7/08/2010 through 9/30/2021)
- Mammography Screening Billing Guidelines (Effective 9/01/10 through 11/29/2021; Replaced with Mammography Screening Payment Policy)
- Maternity Coverage Summary (Effective 3/12/2010 through 7/31/21; Replaced with Obstetrical Services Payment Policy)
- Mediastinum and Diaphragm Coverage Summary (Effective 10/03/2013 through 9/30/2021)
- Multiple Procedure Payment Policy – Archive 1 (Effective 11/01/2020 through 9/28/2021)
- Multiple Procedure Payment Policy – Archive 2 (Effective 9/29/2021 through 3/10/2022)
N
- Never Events Billing Guidelines (Effective 3/01/2021 through 7/01/2021; Replaced with Provider Preventable Condition Policy)
- Nervous Endocrine System Coverage Summary (Effective 10/03/2013 through 9/30/2021)
- New Versus Established Patient Billing Guidelines (Effective 9/01/2010 through 4/30/2021; Replaced with Physician Services Payment Policy on 5/01/2021)
- Non-Covered Services Payment Policy – Archive 1 (Effective 2/28/2017 through 2/14/2021)
- Non-Covered Services Payment Policy – Archive 2 (Effective 2/15/2021 through 7/14/2021)
- Non-Covered Services Payment Policy – Archive 3 (Effective 7/15/2021 through 10/14/2021)
- Non-Covered Services Payment Policy – Archive 4 (Effective 10/15/2021 through 1/11/2022)
- Non-Covered Services Payment Policy – Archive 5 (Effective 1/12/2022 through 5/15/2022 – Click here for a summary of updates)
O
- Observation Evaluation and Management Billing Guidelines (Effective 9/01/2010 through 4/30/2021; Replaced with Physician Services Payment Policy on 5/01/2021)
- Obstetrical Billing Guidelines – Archive (Effective 9/01/2010 through 7/31/2021; Replaced with Obstetrical Services Payment Policy on 8/01/2021)
- Obstetrical Ultrasounds Clinical Medical Policy (CMP #045) – Archive (Effective 11/10/2021 through 7/31/2021; Replaced with Obstetrical Services Payment Policy on 8/01/2021)
- Ophthalmology Billing Guidelines (Effective 9/01/2010 through 2/28/2022; Replaced with Vision Care Services Payment Policy)
- Oral Surgery Benefit Coverage Summary (Effective 7/25/2011 through 11/30/2021; Replaced with Oral Surgery Payment Policy on 12/01/2021)
- Out of Network Payment Policy – Archive 1 (Effective 12/11/2019 through 5/01/2022)
P
- Pain Coverage Summary (Effective 10/03/2013 through 9/30/2021)
- Patient Education Coverage Summary (Effective 9/01/2013 through 9/30/2021)
- Pediatric Critical Care Transport (Effective 9/01/2010 through 4/30/2021; Replaced with Physician Services Payment Policy on 5/01/2021)
- Physician Services Coverage Summary Guidelines (Effective 4/23/2010 through 4/30/2021; Replaced with Physician Services Payment Policy on 5/01/2021)
- Physician Services Payment Policy – Archive 1 (Effective 5/01/2021 through 6/07/2021)
- Physician Services Payment Policy – Archive 2 (Effective 6/08/2021 through 5/01/2022)
- Physical and Occupational Rehabilitation Services Payment Policy – Archive 1 (Effective 9/01/2010 through 9/30/2020)
- Physical and Occupational Rehabilitation Services Payment Policy – Archive 2 (Effective 10/01/2020 through 12/31/2020)
- Physical and Occupational Rehabilitation Services Payment Policy – Archive 3 (Effective 1/01/2021 through 3/31/2021)
- Preventative Medicine Billing Guidelines (Effective 9/01/2010 through 4/30/2021; Replaced with Physician Services Payment Policy on 5/01/2021)
- Psychological Assessment Services Payment Policy (Effective 7/08/2010 through 4/30/2021; Replaced with Physician Services Payment Policy on 5/01/2021)
Q
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R
- Radiology Services Coverage Summary (Effective 4/06/2011 through 9/30/2021)
S
- Special Services Procedures and Reports Billing Guidelines (Effective 9/01/2010 through 4/30/2021; Replaced with Physician Services Payment Policy on 5/01/2021)
- Speech Therapy Services Payment Policy – Archive 1 (Effective 10/01/2020 through 12/31/2020)
- Speech Therapy Services Payment Policy – Archive 2 (Effective 1/01/2021 through 3/31/2021)
- Speech Therapy Services Payment Policy – Archive 3 (Effective 4/01/2021 through 4/30/2022)
T
- Telemedicine Services Payment Policy – Archive 1 (Effective 12/31/2018 through 4/12/2020)
- Telemedicine Services Payment Policy – Archive 2 (Effective 4/13/2020 through 5/6/2020)
- Telemedicine/Telephone Payment Policy (Effective 1/01/2022 through 1/01/2022; See policy for details)
- Temporary COVID-19 Prior Authorization Payment Policy – Archive 1 (Effective 4/01/2020 through 4/27/2020)
- Temporary COVID-19 Prior Authorization Payment Policy – Archive 2 (Effective 4/28/2020 through 7/12/2020)
- Temporary COVID-19 Prior Authorization Payment Policy – Archive 3 (Effective 7/13/2020 through 7/26/2020)
- Temporary COVID-19 Prior Authorization Payment Policy – Archive 4 (Effective 7/27/2020 through 10/21/2020)
- Temporary COVID-19 Prior Authorization Payment Policy – Archive 5 (Effective 10/22/2020 through 12/01/2020)
- Temporary COVID-19 Prior Authorization Payment Policy – Archive 6 (Effective 12/02/2020 through 2/24/2021)
- Temporary COVID-19 Prior Authorization Payment Policy – Archive 7 (Effective 2/25/2021 through 4/15/2021)
- Temporary COVID-19 Prior Authorization Payment Policy – Archive 8 (Effective 4/16/2021 through 6/09/2021)
- Temporary COVID-19 Prior Authorization Payment Policy – Archive 9 (Effective 6/10/2021 through 8/24/2021)
- Temporary COVID-19 Prior Authorization Payment Policy – Archive 10 (Effective 8/25/2021 through 9/30/2021)
- Temporary COVID-19 Telemedicine/Telephone-only Preventive Medicine Visits – Archive 1 (Effective 3/18/2020 through 7/12/2021)
- Temporary COVID-19 Telemedicine/Telephone-only Preventive Medicine Visits – Archive 2 (Effective 7/13/2020 through 7/16/2021)
- Temporary COVID-19 Telemedicine/Telephone-only Preventive Medicine Visits – Archive 3 (Effective 7/17/2020 through 7/26/2020)
- Temporary COVID-19 Telemedicine/Telephone-only Services – Archive 1 (Effective 3/18/2020 through 3/30/2020)
- Temporary COVID-19 Telemedicine/Telephone-only Services – Archive 2 (Effective 3/31/2020 through 4/12/2020)
- Temporary COVID-19 Telemedicine/Telephone-only Services – Archive 3 (Effective 4/13/2020 through 5/6/2020)
- Temporary COVID-19 Telemedicine/Telephone-only Services – Archive 4 (Effective 5/7/2020 through 6/3/2020)
- Temporary COVID-19 Telemedicine/Telephone-only Services – Archive 5 (Effective 6/4/2020 through 7/12/2020)
- Temporary COVID-19 Telemedicine/Telephone-only Services – Archive 6 (Effective 7/13/2020 through 7/16/2020)
- Temporary COVID-19 Telemedicine/Telephone-only Services – Archive 7 (Effective 7/17/2020 through 7/26/2020)
- Temporary COVID-19 Telemedicine/Telephone-only Services – Archive 8 (Effective 7/27/2020 through 5/10/2021)
- Temporary COVID-19 Telemedicine/Telephone-only Services – Archive 9 (Effective 5/11/2021 through 4/7/2022)
- Temporary COVID-19 Testing and Treatment Services Payment Policy – Archive 1 (Effective 3/25/2020 through 3/30/2020)
- Temporary COVID-19 Testing and Treatment Services Payment Policy – Archive 2 (Effective 3/31/2020 through 4/21/2020)
- Temporary COVID-19 Testing and Treatment Services Payment Policy – Archive 3 (Effective 4/22/2020 through 5/12/2020)
- Temporary COVID-19 Testing and Treatment Services Payment Policy – Archive 4 (Effective 5/13/2020 through 5/20/2020)
- Temporary COVID-19 Testing and Treatment Services Payment Policy – Archive 5 (Effective 5/21/2020 through 6/23/2020)
- Temporary COVID-19 Testing and Treatment Services Payment Policy – Archive 6 (Effective 6/24/2020 through 7/12/2020)
- Temporary COVID-19 Testing and Treatment Services Payment Policy – Archive 7 (Effective 7/13/2020 through 7/26/2020)
- Temporary COVID-19 Testing and Treatment Services Payment Policy – Archive 8 (Effective 7/27/2020 through 8/16/2020)
- Temporary COVID-19 Testing and Treatment Services Payment Policy – Archive 9 (Effective 8/17/2020 through 9/01/2020)
- Temporary COVID-19 Testing and Treatment Services Payment Policy – Archive 10 (Effective 9/02/2020 through 10/14/2020)
- Temporary COVID-19 Testing and Treatment Services Payment Policy – Archive 11 (Effective 10/15/2020 through 1/05/2021)
- Temporary COVID-19 Triage Services Provided Via Telephone Only (Effective 3/09/2020 through 3/18/2020; Replaced with Temporary COVID-19 Telemedicine/Telephone-only Payment Policy)
U
- UB04 General Claim Submission (Effective 10/03/2013 through 9/30/2021; Refer to Provider Manual)
V
- Venous Procedure with Surgery Billing Guideline (Effective 9/01/2013 through 9/30/2021)
- Vision Care Services Billing Guidelines (Effective 7/01/2011 through 2/28/2022; Replaced with Vision Care Services Payment Policy)
W
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X
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Y
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Z
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