Rhode Island Billing Guide for Mental Health Therapists and Psychiatrists
Who pays, where to enroll and which rules change your claims in Rhode Island, for psychotherapists and psychiatric prescribers.
Last checked October 25, 2026. Reviewed against the official sources listed at the bottom of this page.
This Rhode Island billing guide covers Medicaid, Medicare, Blue Cross, other private payers and state law for therapists and psychiatrists, with sources and a last-checked date.
Rhode Island billing guide: how Rhode Island pays for outpatient care
The Executive Office of Health and Human Services (EOHHS) runs Rhode Island Medicaid. EOHHS lists three Medicaid managed care plans (Neighborhood Health Plan of Rhode Island, Tufts Health Public Plans/RITogether and UnitedHealthcare of New England), and Gainwell Technologies is the fiscal agent for fee-for-service claims through the RI Medicaid Healthcare Portal.
EOHHS training and manual documents set a 12-month (365-day) filing limit for fee-for-service claims, with 90-day exceptions for older claims. Blue Cross & Blue Shield of Rhode Island (BCBSRI) is the Blue licensee, with a 180-day filing limit for participating providers on commercial products. Medicare Part B claims go to National Government Services (Jurisdiction K). StayCovered RI says federal Medicaid work requirements for expansion adults start in 2027, with reporting at the first renewal in 2027, and exempts people with a mental health condition or substance use disorder that makes it hard to work.
Who to bill, at a glance
| Payer type | Who you bill | Where to enroll or check rules |
|---|---|---|
| Medicaid | Rhode Island Medicaid (EOHHS), including RIte Care and Medicaid expansion; managed care plans plus fee-for-service: Rhode Island Executive Office of Health and Human Services (EOHHS) | Provider enrollment |
| Medicare Part B | National Government Services, Inc. (NGS) | CMS MAC page |
| Blue Cross Blue Shield | Blue Cross & Blue Shield of Rhode Island (BCBSRI) | See the Blue Cross section below |
Rhode Island Medicaid and how to bill it
This Rhode Island billing guide starts with Medicaid, because it decides who pays and how you file.
EOHHS posts contracts for three Medicaid managed care plans (Tufts Health Public Plan, UnitedHealthcare of New England and Neighborhood Health Plan of Rhode Island). Fee-for-service claims go to Gainwell. The Billing 101 and General Guidelines documents say they do not cover managed care billing rules, so plan-specific rules come from each plan's manual.
| Item | What to know |
|---|---|
| Agency | Rhode Island Executive Office of Health and Human Services (EOHHS) |
| Claims or fiscal agent | Gainwell Technologies, fiscal agent contracted by EOHHS; fee-for-service claims, enrollment and eligibility through the RI Medicaid Healthcare Portal (www.riproviderportal.org). Electronic claims via free Provider Electronic Solutions (PES) software or paper. |
| Provider enrollment | Official enrollment page |
| Manual or fee schedule | Official manual or fee schedule |
| Provider portal | Provider portal |
| Work requirement | StayCovered RI (updated Oct 19, 2026) says some adults on Medicaid will have to meet new federal work requirements starting in 2027, and reporting starts at the first renewal in 2027; renewals move from yearly to every six months. |
Managed-care plans and carve-outs
| Plan or entity | Role in behavioral health |
|---|---|
| Neighborhood Health Plan of Rhode Island (NHPRI) | Listed by EOHHS as a Medicaid managed care contractor. |
| Tufts Health Public Plans (Tufts Health RITogether) | Listed by EOHHS as Tufts Health Public Plan. |
| UnitedHealthcare Community Plan of Rhode Island (UnitedHealthcare of New England) | Listed by EOHHS as UnitedHealthcare of New England. |
Timely filing: EOHHS General Guidelines v1.6 say fee-for-service claims must be received by Gainwell within 365 days of the date of service (Billing 101 says twelve months).
Medicare Part B in Rhode Island
For Medicare, this Rhode Island billing guide names your contractor and the current telehealth rules.
As of 2026-10-25, per the CMS Telehealth FAQ (updated 10/8/26): Medicare telehealth flexibilities run through December 31, 2027, including audio-only at home.
| Item | What to know |
|---|---|
| Contractor | National Government Services, Inc. (NGS) |
| Jurisdiction | Jurisdiction K (JK): Connecticut, Maine, Massachusetts, New Hampshire, New York, Rhode Island and Vermont. |
| Source | CMS.gov MAC page |
Blue Cross Blue Shield in Rhode Island
This part of the Rhode Island billing guide names the exact Blue Cross licensee, because Blue plans never share rules.
Blue Cross Blue Shield is a federation of independent companies, so one licensee's rules never apply to another. Here is who holds the Blue license in Rhode Island.
| Licensee | Parent or affiliation | Where it applies | Provider resources |
|---|---|---|---|
| Blue Cross & Blue Shield of Rhode Island (BCBSRI) | Blue Cross Blue Shield Association licensee | Rhode Island. | Source |
Other private payers and EAPs in Rhode Island
The Rhode Island billing guide also covers commercial plans and employee assistance programs.
These commercial payers and plan families most often matter for behavioral health billing in Rhode Island. Check each payer's current provider manual before you submit.
| Payer | Behavioral health note | Provider resources |
|---|---|---|
| UnitedHealthcare / Optum Behavioral Health | UnitedHealthcare's contact page lists Behavioral health 877-614-0484 and Provider Services 877-842-3210; its only Rhode Island entry is All Savers Health Plan (800-291-2634) plus a Network Management address in Warwick, RI. | Official page |
| Neighborhood Health Plan of Rhode Island (commercial and other lines) | Optum's notice says NHPRI manages behavioral health across all of its lines of business from Sept. 1, 2025. | Official page |
| Aetna | Aetna's health care professionals contact page lists one number for indemnity and PPO-based plans (1-888-632-3862). It lists no Rhode Island specific data and no date. | Official page |
| Cigna / Evernorth Behavioral Health | Cigna provider contact page lists 800-882-4462 for customer service, credentialing, appeals and precertification and 800-926-2273 for Evernorth Behavioral Health. | Official page |
Rhode Island billing guide: state law that changes billing
Use this section of the Rhode Island billing guide to separate state law from payer policy.
State law sets the floor for commercial plans in Rhode Island. Medicare and Medicaid rules are covered in their own sections above.
Mental health parity
R.I. Gen. Laws 27-38.2-1 requires group and individual health plans to cover mental illness and substance use disorders under the same terms and conditions as coverage for other illnesses and diseases. Citation: R.I. Gen. Laws 27-38.2-1. Source
Telehealth coverage and payment parity
R.I. Gen. Laws 27-81-4 (amended by P.L. 2021 ch. 184 and ch. 199, effective July 6, 2021) requires insurers to cover covered services delivered by telemedicine when medically necessary and clinically appropriate. Telemedicine services delivered by in-network behavioral health providers must be reimbursed at rates not lower than the same provider's in-person services. Citation: R.I. Gen. Laws 27-81-4. Source
Prompt payment and timely filing
230-RICR-20-30-6 (Prompt Processing of Claims; current version effective 01/04/2022) requires payment within 30 calendar days of receiving a complete electronic claim and 40 calendar days for a complete paper claim, written notice of denial or pend reasons within 30 days, and 12 percent annual interest from day 31 (electronic) or day 41 (paper). Citation: 230-RICR-20-30-6; R.I. Gen. Laws 27-18-61. Source
Practitioner scope: therapists and prescribers
EOHHS Clinician's Services lists covered provider types including physicians, psychiatric nurses, psychologists, CSW/CISW social workers, counselors, marriage and family therapists and mental health counselors (several only when employed by a community mental health center or approved agency), and associate clinicians (LMFT-A, LMHC-A, LCSW-A) who may enroll only as part of a group. Source
Not legal advice. Confirm statute details with counsel.
Rhode Island billing guide: codes and rates
This Rhode Island billing guide lists only codes and rates confirmed on official pages.
These are the Rhode Island-specific codes, modifiers and rate items confirmed on official pages.
| Code or item | What to know |
|---|---|
| Medicaid managed care telemedicine codes (POS 02) | Addendum A v.3 (effective 7/1/2023): behavioral health codes are reimbursable at in-home or in-office rates when billed with POS 02, one unit per date of service. Source |
| Behavioral health rate increases, FY2027 budget | EOHHS (page updated Oct 7, 2026) says the FY2027 enacted budget includes OHIC-recommended increases for behavioral health effective October 1, 2026, applied retroactively if implementation runs past that date; where an OHIC recommendation exceeds Medicare, the Medicare rate applies. Source |
| Physician assistant modifier U8 (Medicaid) | October 2026 Provider Update: starting October 1, 2026, physician assistants must bill listed codes with the U8 modifier in the first position. Source |
Rhode Island billing guide: what changed, newest first
Check this Rhode Island billing guide update log before you rely on an older rule.
| Date | What changed | Source |
|---|---|---|
| 2026-10-19 | StayCovered RI updated its work and community engagement requirement pages: requirements start in 2027, reporting begins at the first renewal in 2027, and people with a qualifying mental health condition or substance use disorder, or in a treatment program, are exempt. | Source |
| 2026-10-08 | CMS Telehealth FAQ updated: Medicare telehealth flexibilities through 12/31/2027; in-person requirement for mental health telehealth effective after 12/31/2027. | Source |
| 2026-10-07 | EOHHS FY2027 budget page: behavioral health rate increases effective October 1, 2026, applied retroactively if implementation is delayed; the 10/1/2026 fee schedule is posted on EOHHS's Fee Schedules page. | Source |
| 2026-10-01 | BCBSRI's 2026 Behavioral Health Integration Services policy, including the Collaborative Care Model, took effect and was updated to identify which provider types are or are not eligible for the listed codes. | Source |
| 2026-10-01 | RI Medicaid: physician assistants must bill listed codes with the U8 modifier in the first position starting October 1, 2026. | Source |
| 2026-08-31 | Deadline passed for providers to contact Neighborhood Health Plan of RI about behavioral health claims with dates of service before 9/1/2025 (those went to Optum); NHPRI says it will not review such requests after that date. | Source |
How do I bill mental health claims in Rhode Island?
These answers come from the same sources as the rest of this Rhode Island billing guide.
The Executive Office of Health and Human Services (EOHHS) runs Rhode Island Medicaid. EOHHS lists three Medicaid managed care plans (Neighborhood Health Plan of Rhode Island, Tufts Health Public Plans/RITogether and UnitedHealthcare of New England), and Gainwell Technologies is the fiscal agent for fee-for-service claims through the RI Medicaid Healthcare Portal. Start with the member's payer type: Medicaid plan, Medicare Part B, a Blue Cross licensee or another commercial plan.
Questions about billing in Rhode Island
How long do I have to bill Rhode Island Medicaid fee-for-service claims?
EOHHS's General Guidelines say claims must be received by Gainwell within 365 days of the date of service. Claims over one year old need a listed exception, such as retroactive eligibility or a prior Medicaid denial, and must then be submitted within 90 days of the remittance advice or other payer's EOB date. Managed care plans set their own deadlines, so check each plan's manual.
Who do I bill for a Rhode Island Medicaid member in a managed care plan?
EOHHS lists three Medicaid managed care plans: Neighborhood Health Plan of Rhode Island, Tufts Health Public Plans (RITogether) and UnitedHealthcare of New England. Plan members' claims go to the plan, and fee-for-service claims go to Gainwell through the RI Medicaid Healthcare Portal. You must be enrolled with RI Medicaid first, and each plan then adds you to its network.
What is the BCBSRI timely filing limit for therapy and psychiatry claims?
BCBSRI's claims page and payment policy say participating providers must file commercial claims within 180 days of the date of service. Nonparticipating providers have 365 days. BCBSRI notes that contracts may differ and supersede the policy, so check your agreement.
Does Rhode Island require insurers to pay behavioral health claims promptly?
Yes. Under 230-RICR-20-30-6, insurers must pay a complete electronic claim within 30 calendar days and a complete paper claim within 40 calendar days, and must send written notice of a denial or pend within 30 days. Interest accrues at 12 percent a year after those windows. This rule covers commercial insurers, not Medicaid fee-for-service.
Does MCM South bill for practices in Rhode Island?
MCM South currently serves ten states; request a quote to ask about Rhode Island.
Sources for the Rhode Island billing guide
Last checked October 25, 2026. Every source below was opened and read on that date.
- EOHHS Billing 101, RI Medicaid Provider Training Days (2026-05 file), checked October 25, 2026
- EOHHS RI Medicaid Provider Reference Manual, General Guidelines v1.6, checked October 25, 2026
- EOHHS Medicaid Managed Care contracts and guidance (last updated Oct 20, 2026), checked October 25, 2026
- EOHHS Medicaid Managed Care Manual page (last updated May 18, 2026), checked October 25, 2026
- EOHHS Medicaid Provider Manual: Clinician's Services (last updated Apr 28, 2026), checked October 25, 2026
- EOHHS Addendum A: Telemedicine Mandatory Minimum Codes for Medicaid Managed Care, checked October 25, 2026
- EOHHS press release: three health plans sign 5-year Medicaid contract (Apr 20, 2017), checked October 25, 2026
- EOHHS FY2027 Medicaid Budget Initiatives (last updated Oct 7, 2026), checked October 25, 2026
- EOHHS Provider Update, October 2026, Vol 405, checked October 25, 2026
- StayCovered RI: Community engagement requirements (updated Oct 19, 2026), checked October 25, 2026
- StayCovered RI: Work requirements (updated Oct 19, 2026), checked October 25, 2026
- CMS Telehealth FAQ (updated 10/8/26), checked October 25, 2026
- CMS: A/B MAC Jurisdiction K (JK), checked October 25, 2026
Related guides
- State & Regional Billing Guides hub
- In-network vs out-of-network credentialing
- Credentialing and network status
- Mental health parity explained
- Medicaid managed care billing
- Medicare behavioral health billing
- Timely filing in the billing glossary
- Who we serve
- Massachusetts insurance companies contact guide
- Connecticut insurance companies contact guide
- New York insurance companies contact guide
- Pennsylvania insurance companies contact guide
Billing in Rhode Island? Let us handle the payer calls.
MCM South bills only mental and behavioral health, for psychotherapists and psychiatrists, in solo and medium-size practices. We currently serve ten states; request a quote to ask about Rhode Island.
MCM South currently serves practices in ten states: Georgia, Massachusetts, Connecticut, Texas, Florida, New York, Colorado, Tennessee, North Carolina and Illinois.