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Neighborhood Health Plan of Rhode Island
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        • Neighborhood has been helping Rhode Island families stay healthy for almost 30 years by providing access to excellent health care.

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        • Welcome to Neighborhood’s Commercial Member plan section. If you purchased a health plan through HealthSource RI or have a plan through your small employer, find information about your benefits here.

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        • Welcome! We are happy to offer a health and drug plan for Rhode Islanders eligible for both Medicare and Medicaid — Neighborhood INTEGRITY (Medicare-Medicaid Plan).

April 2021

Neighborhood News 

Announcements and Reminders

  • Guidance for Scheduling Pediatric Preventive Care
  • HealthSourceRI offering Special Enrollment Period
  • Payment Policy Update
  • Hospital Readmission Payment Policy
  • Provider Satisfaction Survey Results
  • Sign-up for Email from Neighborhood 
  • Neighborhood Quick Reference Guide

 

Operational Efficiencies

  • Searchable Prior Authorization Guide
  • New Process for Updating Provider Information
  • Member Site Change Requests – Updated Form
  • NaviNet Enhancement – Claim Denial Details

 

Quality Improvement

  • Metabolic Monitoring for Children and Adolescents on Antipsychotics
  • HEDIS: Initiation and Engagement of Alcohol and Other Drug Abuse or Dependence Treatment (IET)
  • Access to Care Standards

 

Behavioral Health

  • Behavioral Health News Articles and Resources
  • Optum Claim Submission Requirements

 

Claims

  • Claims Corner: Submission reminders, forms, and more .
  • Provider Appeal Process and Timeline

 

Pharmacy

  • Medicaid Formulary Changes
  • How to Bill 340B Appropriately
  • Specialty Medication Prior Authorization Criteria – Reminder
  • Electronic Prior Authorization (ePA) for the Pharmacy Benefit
  • Medical Benefit Prior Authorization Submissions
  • Searchable Formulary for Pharmacy Benefit and Medical Pharmacy Medications

 

The News and Updates section of the Neighborhood website is used to share important news and information, including notifications on payment policies, operational issues, and more.

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