Practices in Rhode Island pay 4-8% of collections for billing, with no long-term contract, and can add credentialing. RI Medicaid, Medicare and commercial plans, billed for Providence, Warwick, Cranston and the rest of the state.
Rhode Island Medicaid managed care runs through three plans: Neighborhood Health Plan of Rhode Island, Tufts Health Public Plans and UnitedHealthcare Community Plan. Neighborhood Health Plan is a nonprofit plan built for the state.
As the smallest state by area, Rhode Island has a compact payer landscape, with Blue Cross Blue Shield of Rhode Island as a major commercial insurer. Rhode Island law requires clean claims paid within 30 days if electronic and 40 days on paper, with 12% annual interest after that.
Why Clinics in Rhode Island Rely on Medtransic
Rhode Island Payer Billing
Each payer billed to its own rules, starting with Rhode Island Medicaid
Coders Matched to Your Specialty
A therapy practice gets coders who know therapy, and the same goes for psychiatry or ABA
Dedicated Account Manager
Someone who knows your practice, your payers and your open claims
No Long-Term Contract
We are paid 4-8% of collections, and there is no long-term contract to get out of
What Care Teams in Rhode Island Count On Us For
RI Medicaid Billing
Billing for Neighborhood Health Plan of Rhode Island, Tufts Health Public Plans and UnitedHealthcare Community Plan
HIPAA Compliant
Your patient data stays HIPAA compliant, and a dedicated account manager handles your questions
Providence is Rhode Island's healthcare hub. Brown University Health (Rhode Island Hospital, The Miriam Hospital, Newport Hospital) and Care New England Health System serve a densely populated market, with academic medicine through Brown University's Warren Alpert Medical School.
Blue Cross Blue Shield of Rhode Island, UnitedHealthcare and Point32Health's Tufts Health Plan are among the commercial payers Providence practices bill.
Northern Rhode Island: Woonsocket, Pawtucket & Lincoln
Northern Rhode Island is served by Landmark Medical Center in Woonsocket and Care New England's Memorial Hospital of Rhode Island in Pawtucket. Many residents carry Massachusetts-based commercial plans.
Patients often cross into Attleboro and Fall River for care, so practices bill Blue Cross Blue Shield of Massachusetts and other Massachusetts plans alongside Rhode Island ones.
Specialties: Primary care, family medicine, internal medicine, behavioral health, cardiology
Newport & South County
Newport's healthcare market is anchored by Newport Hospital and South County Hospital in Wakefield, serving coastal communities, Naval Station Newport and summer visitors. TRICARE claims and out-of-state visitor claims are part of everyday billing here.
Summer tourism raises claim volume, while Naval Station Newport brings TRICARE claims year-round.
Specialties: Family medicine, urgent care, orthopedics, military medicine, primary care
Frequently Asked Questions About Medical Billing in Rhode Island
How does Rhode Island Medicaid managed care billing work?
Rhode Island Medicaid managed care runs through three plans: Neighborhood Health Plan of Rhode Island, Tufts Health Public Plans and UnitedHealthcare Community Plan. Each plan has its own authorization rules, enrollment and claims process.
What are the prompt-pay rules for Rhode Island claims?
R.I. Gen. Laws 27-18-61 requires clean claims to be paid within 30 days if filed electronically and 40 days if written. Interest of 12% a year applies from day 31 or day 41.
Does Rhode Island have a surprise billing protection law?
Most surprise out-of-network bills are off limits under the federal No Surprises Act, which took effect in January 2022. Rhode Island patients usually owe only in-network cost sharing for emergency care and for out-of-network care at in-network facilities.
What's the claim-filing window for Rhode Island practices?
Under 42 CFR 424.44, a Medicare claim must be filed within 12 months of the service date. Each commercial plan and Medicaid health plan sets its filing window in its own contract, so the deadline has to be read from that contract.
Nearby States We Also Serve
Our coverage doesn't stop at the Rhode Island border - nearby states we also serve:
Get Started with Medical Billing Services in Rhode Island
Want a second look at your Rhode Island practice's billing? Contact Medtransic for a free, no-obligation practice assessment. Call us at 888-777-0860 or submit a contact form, and let us handle the billing so you can focus on your patients.