The Medicaid Program posted its December 2024 Provider Update. All previous provider updates may be found here.

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

Please see the October 2024 Provider Update from Medicaid. All previous provider updates may also be found online.

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

Please see the June 2024 Provider Update from Medicaid. All previous provider updates are available online. 

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

Please see the April 2024 Provider Update from Medicaid. All previous provider updates may also be on this webpage.

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

Please see the March 2024 Provider Update RI Medicaid. All previous provider updates may also be found here.

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

Please see the most recent Medicaid Provider Update (January 2024). All provider updates dated back to 2019 are available online.

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

Please see the November 2023 provider update. Previous updates can also be found on the Executive Officer of Health and Human Services (EOHHS) Provider Updates web page.  

Also in Rhode Island, Medicaid has noticed an increase in the number of Continuous Glucose Monitors (CGMs) submitted via pharmacy claims. Please note that Medicaid considers CGMs as DME products and requires prior authorization for all CGM-related items. All prior authorization requests must be submitted by the dispensing provider and must include a prescription and recent clinical notes. Requests submitted directly by ordering physicians will be returned. 

• Coverage guidelines can be found here: CGM Policy Final 091222.pdf (ri.gov) 
• Prior authorization forms and instructions can be found here: Prior Authorization | Executive Office of Health and Human Services  

In adherence with recent Medicare HCPCS code updates, Medicaid activated the following CGM codes: 

• A4239 – SUPPLY ALLOWANCE FOR NON-ADJUNCTIVE, NON-IMPLANTED CONTINUOUS GLUCOSE MONITOR (CGM), INCLUDES ALL SUPPLIES AND ACCESSORIES, 1 MONTH SUPPLY = 1 UNIT OF SERVICE 
• E2103 – NON-ADJUNCTIVE, NON-IMPLANTED CONTINUOUS GLUCOSE MONITOR OR RECEIVER  

Effective October 1, 2023, prior authorization requests submitted under codes K0553 and/or K0554 are being returned and must be resubmitted with the proper codes. 

Claim submission for reimbursement must be done using either the 837 professional file format or via the CMS 1500 paper claim. Claims submitted otherwise will be denied. 

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

Please see the most recent Provider Update for Medicaid. All provider updates may also be found here.  

Also in Rhode Island, effective October 1, 2023, Katie Beckett recipients will now be enrolled in a managed care organization for Case Management Services only. Case Management services are provided by CEDARR Center Providers. All other services will still be reimbursed through Medicaid fee for service.  

When checking eligibility on the Healthcare Portal (HCP) you will see the following (see sample picture below): 

1. A new row under Benefit Plan Details – Katie Beckett Case Management
2. A new row under Managed Care Details – Displays the name and dates of the Managed Care Plan the recipient is enrolled in. 

If you are a CEDARR provider and the recipient is enrolled in the Katie Beckett case management program, then you must bill your services to the managed care plan on file. All other providers will continue to bill Medicaid Fee for Service. 

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

The state issued a Provider update. Please find here the link to the August Provider Update.

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.