Medicaid Enrollment Required to Keep Network Status Active, Prevent Claim Denials  

All Medicaid managed care network providers, regardless of specialty or service model, must be screened by and enrolled with the State of Rhode Island Medicaid program. If you provide services to a Medicaid member without completing this step, claims may be denied. You risk being removed from the Rhode Island Medicaid Managed Care Network.  

How to enroll:

1. Access the application for the enrollment/screening on the Rhode Island Medicaid Healthcare Portal. 
   
2. Go to Provider Enrollment then select Enrollment Application. 
3. Select MCO (Managed Care Organization) Provider in the Type of Provider Enrollment drop-down menu, then indicate your MCO affiliation. 
4. Submit the application. 

Work with more than one MCO? You only need to submit one application. Once your application is approved and your screening complete, you’ll need to request the Medicaid network be added to each of your MCO profiles.

To have the Medicaid network added to your Optum profile, please email your request and include a copy of your approval letter from Gainwell.

Already been screened by Medicare?

Rhode Island Medicaid will rely on Medicare's screening. However, you will need to complete the disclosure statements for the Medicaid screening. Providers not screened by Medicare may be required to pay an application fee.

Questions?

The Medicaid enrollment and screening is required by the 21st Century Cures Act 114 P.L. 255.

For more information, review the Provider Enrollment User Guide or the FAQ's. If you need additional assistance, please email Rhode Island Provider Services. You may also contact the Rhode Island Customer Service Help Desk at 1-401-784-8100 and 1-800-964-6211 (toll-free).