We’ve communicated in previous issues of Insights and Updates for Providers that Rhode Island Medicaid providers are required to complete screening and enrollment with the state Medicaid program in order to receive payment for services administered to our Tufts Health RITogether members.
In the event that a claim is denied due to a provider’s Rhode Island Medicaid screening status (or any other reason), it’s important to note that the member cannot be balance billed, which occurs when a provider bills the member for any amount Medicaid does not pay.
Balance billing is prohibited by Point32Health and by the Rhode Island Executive Office of Health and Human Services; our providers are not permitted to charge Medicaid beneficiaries (e.g., Tufts Health RITogether members) for covered services.
To ensure that you can receive reimbursement for Tufts Health RITogether members and remain in our Tufts Health Public Plans network in the future, we encourage you to apply for enrollment/screening on the RI Medicaid Healthcare Portal.