Claims Corner: New Electronic Claims Submission

Summer 2016


As ever, the Claims Department is dedicated to implementing processes and programs with a goal of improving overall provider satisfaction. Recently, we’ve had many exciting changes come about, and we’re thrilled to share the news!

  • Neighborhood Health Plan of Rhode Island has partnered with ABILITY to offer our network providers a way to submit claims electronically – free of charge for all Neighborhood claims. While ABILITY is a clearinghouse that can also assist you in submitting claims to your other payors, there will be a charge assessed for those submissions. ABILITY will be reaching out to providers currently submitting paper claims. If you’re interested in increasing efficiency and getting your claims paid quicker, we encourage you to participate! If you’re interested in signing up immediately, please send the following information via secure email to:
    • Name
    • Address
    • City
    • State
    • Zip
    • Phone
    • NPI (group and/or rendering)
    • Tax ID
  • Providers will now hear a new menu when calling into the provider claims services line. Neighborhood has made these changes to better align with our product offerings and deliver the best possible service to our provider community.



  • Please remember: if a code requires an NDC, those codes must be submitted with a valid NDC or your claim will be denied. For those providers who use a clearinghouse to submit claims, please be sure that clearinghouse is set up to transmit this information.
  • Claims that need to be corrected or voided can now be submitted electronically. There is no longer a need to submit these on paper. Please be sure to follow the appropriate EDI guidelines.
  • Please be sure to use the correct payor ID when submitting claims to avoid timely filing denials. Effective 5/1/2016, Neighborhood will no longer make exceptions to pay claims that have been denied due to incorrect payor ID.
    • Commercial Exchange and Integrity products Payor ID is: 96240
    • Medicaid products Payor ID is: 05047