The Rhode Island Executive Office of Health and Human Services (EOHSS) has implemented a rate increase for physicians billing for pediatric services for members under 21 years of age. The rate increase is retroactive for dates of service on or after July 1, 2022, and Tufts Health Plan is automatically reprocessing applicable claims to ensure eligible providers receive the appropriate reimbursement.
The rate increase applies the following provider types (but is not applicable for specialists) when billing for pediatric services for Tufts Health RITogether members under 21 years of age:
- Internal medicine
- Family medicine
- General practitioners
- Nurse practitioners
- Physician assistants
Please refer to the chart below for applicable codes and rates.
Applicable codes and rates for pediatric services for Tufts Health RI Together Members
Claims submitted for pediatric services with a date of service on or after July 1, 2022 will automatically be reprocessed by Tufts Health Plan to be reimbursed at the applicable rate. “Lesser of” language in the contract will not apply to retro processing claims only. Retroactively processed claims will reimburse at the higher rate, even if the lower rate was billed for this specific timeframe of July 1, 2022 through January 5, 2023. Effective January 5, 2023 “Lesser of” language shall apply.
Director, Provider Relations & Communications
Senior Manager, Provider Communications
Joseph O’Riordan, Jesse Salvato, Stephen Wong