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Rhode Island Provider Resources

21st Century Cures ACT

  • The 21st Century Cures Act (Cures Act) 114 P.L. 255 requires all States to screen and enroll all Medicaid providers, both those in Medicaid fee-for-service (FFS) and managed care organizations (MCOs). Medicaid managed care network providers, regardless of specialty, are required to be screened by and enrolled with the State Medicaid Agency. Federal laws enforced by CMS, including the Affordable Care Act and the 21st Century Cures Act, require states to screen and enroll all providers. Providers who do not comply with this requirement risk being removed from the Rhode Island Medicaid managed care network.
  • RI Executive Office of Health and Human Services (EOHHS) has begun the screening and enrollment process providing the following FAQ to assist you with your enrollment. If you have additional questions or concerns that are not answered by the EOHHS Provider Enrollment User Guide, please contact our EOHHS Customer Service Help Desk at (401) 784-8100 for in-state and long-distance calls, or 800-964-6211 for in-state toll calls. You may also email RIProviderServices@gainwelltechnologies.com.

Optum Network Manual

Clinical Criteria

Best Practice Guidelines

Coordination of Care (COC)

 

Additional information and forms are available, including psych/neuropsych testing guidelines, credentialing plans, and Disability Solutions Manual, on the Provider Express Guidelines/Policies & Manuals and Optum Forms pages.

 

Rhode Island Resources

Neighborhood Health Plan of Rhode Island

If you have questions regarding NHP of Rhode Island directives related to COVID-19, please contact your Provider Relations Advocate.