Neighborhood is contracted with NaviNet to provide online member benefit, eligibility, and claims status lookup. Both contracted and non-contracted (out-of-network) providers can use NaviNet. Click here to access the NaviNet website. For additional help or information, contact Neighborhood Provider Services at 1-800-963-1001.
Click here for a guide to assist NaviNet users to cross-reference Neighborhood Plan ID numbers with NaviNet Group ID Numbers.
Claims Submission Information
For information and guidance on requesting an adjustment to a previously processed claim(s), please click here.
Electronic Claims:
- Medicaid Claims Payer ID 05047
- Exchange/Commercial and INTEGRITY (Medicare-Medicaid Plan) Claims Payer ID 96240
Paper Claims:
Neighborhood Health Plan of Rhode Island
P.O. Box 28259
Providence, RI 02908-3700
Each Neighborhood line of business has certain levels of appeal and submission timeframes, outlined in the Provider Appeal Process and Timelines reference table.
INTEGRITY Provider Appeal Rights
Participating Providers: Please consult Neighborhood’s Provider Manual for appeal rights
Non-participating Providers:
If you disagree with the amount of the payment or denial for the service(s) rendered, you have the right to request a reconsideration or appeal. You must file your appeal within 60 days of the date on the remittance notification. To file an appeal, send a written appeal to Neighborhood Health Plan of Rhode Island Attn: Grievance and Appeals Coordinator 910 Douglas Pike Smithfield, RI 02917. Please supply additional written documentation with your appeal to include comments, clinical records, or other documentation that supports your appeal. We will review our initial decision and notify you in writing of the outcome of your appeal. We will respond to administrative appeals within 60 calendar days and medical necessity appeals within 30 calendar days of receipt. Please note if you choose to appeal, you must also submit a signed Waiver of Liability, which holds our member harmless regardless of the appeal outcome. Form can be found at:
https://www.cms.gov/Medicare/Appeals-and-Grievances/MMCAG/Downloads/Waiver-of-Liability-Notice.pdf