Spring 2018
Billing Claims for Neighborhood INTEGRITY (Medicare-Medicaid Plan) Services
All claims for INTEGRITY MMP members should be billed directly to Neighborhood, and not to Medicare. Claims for services previously considered Medicare-only or Medicaid-only should be submitted to Neighborhood in the same format as they were previously submitted to Medicare or Medicaid.
Neighborhood Health Plan of Rhode Island vs. Neighborhood Health Plan of MA
Each Neighborhood Health Plan is a separate entity; there is no affiliation between them. Please avoid violating PHI rules by sending only claims for members of Neighborhood Health Plan of Rhode Island to PO Box 28259, Providence, RI 02908-3700.
Corrected (Replacement)/Voided Claims
A Corrected (Replacement)/Voided Claim Request Form must accompany the UB-04 or CMS-1500 claim form when submitting a replacement or voided claim on paper. The original claim number must be provided on the request form, as well as in Field 64 on a UB-04 (Institutional) claim form or in Field 22 on a CMS-1500 (Professional) claim form. Follow the instructions on the request form to prevent claims from being returned. Requests submitted without the original claim number will be returned to the sender.
Requests for Adjustments
A request for an adjustment must be submitted on an Adjustment Request Form, which is located on the Neighborhood website in the Provider section, under “Provider Manual and Newsletter” in the Claim Forms section of the Provider Manual Forms menu. Follow the instructions on the request form to prevent requests being returned. Do not attach a claim to the adjustment request. Adjustment requests accompanied by a claim form will be returned to the provider.
Claim Resubmission Grid
When using the Claim Resubmission Grid on the website, be sure to download it and save it before data is added, or changes will not be saved. Click out of a cell after typing to enable the “Save” icon at the top of the screen.
Current Forms
Please remember to use the most current request forms available on our website. Provider request forms are available in the Claim Forms section of the Provider Manual Forms menu on the Neighborhood website. The Corrected (Replacement)/Voided Claim, Reconsideration, Adjustment, and Appeal request forms are writeable, allowing them to be typed online, then printed and submitted to Neighborhood. Outdated forms will be returned to the sender for correction.
For help deciding which form to use, the Claim Form Finder, located in the Claim Forms section of the Provider Manual Forms menu on the Neighborhood website can help to determine which form must be completed and submitted to Neighborhood, along with additional information related to the submission of each form.