Welcome to the Optum Network!
21st Century Cures Act – Screening/Enrollment
If a provider has not been screened and enrolled as a Rhode Island Medicaid Provider, all claims/encounters with dates of service on or after November 1, 2023, shall not be accepted by Rhode Island Medicaid and will not be considered or count towards future rate setting.
Any Provider who has not completed 21st Century Cures Act enrollment by November 1, 2023 will have their patients assigned to another clinician and will be terminated from the Rhode Island Medicaid program.
Keep your billing privileges by completing your state screening and enrollment.
Optum Network Manual
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.
- Agency Billing
- RI Telehealth Guidance
- Facility IOP Pre-auth Updates
- Express Access Network
- Important Information Related to Claims Payment
- New Medicare Advantage plans for members in your area
- NPI and Taxonomy requirements on claim submissions information
- Provider Express – Key Links
- Rhode Island Medicaid Prior Authorization Approval Notice
- RI COB Provider Training
- RI Provider Appointment Availability
- RI UHC C&S prior auth and notification information
- Optum Networks Overview
- Optum and NHPRI Escalation Process
- Optum and UHC Community & State Escalation Process
- Updating Provider Directory Data – Directory Attestation Guide
- Viewing Provider Remittance Advice
- Virtual Visit Attestation Information
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.
We are providing links to support required training for providers serving Neighborhood Health Plan of Rhode Island (NHP of RI) INTEGRITY members.
Click here to learn about training and attestation requirements and to access links to training provided by NHP of RI.
After completing the trainings, you will be asked to attest to having completed those and, at that time, will also be asked to attest to information related to these topics:
- Neighborhood Policies and Procedures
- Provider Rights and Responsibilities
- ADA Compliance, Accessibility and Accommodations
- Cultural Competency Training
- INTEGRITY (Medicare-Medicaid Plan) Training