Statewide Healthcare RCM Coverage • 31 Cities & Towns
Medical Billing & RCM Services in Rhode Island
Delivering tailored medical coding, billing, and credentialing services across Rhode Island. Serving healthcare providers, clinics, and hospital groups with an exceptional 98% clean claim rate.
Statewide Regulatory & MAC Compliance Hub
Rhode Island Medicare MAC Jurisdiction & Payer Regulations (J-K)
Comprehensive Part A/B Medicare contractor policies, LCD standards, and state Medicaid filing rules for Rhode Island medical practices.
98.2% First-Pass Clean Claim Rate
Medicare Administrative Contractor (MAC)
J-K
Jurisdiction K (J-K)
Contractor:
National Government Services, Inc. (NGS) (HQ: Indianapolis, IN)
State Medicaid & Public Health Agency
RI
Rhode Island Executive Office of Health & Human Services (RI Medicaid)
Governing Agency:
Rhode Island Executive Office of Health and Human Services (EOHHS)
Medicaid Timely Filing:
365 days from Date of Service / 90 days from Medicare RA
Medicare Timely Filing Window
12 months (365 days) from Date of Service
First-Level Appeals (Redetermination)
120 calendar days from Remittance Advice (Redetermination)
First-Pass Clean Claim Target
98.2% Scrubber Rate
Active Local Coverage Determinations (LCDs) in Rhode Island (J-K):
4 Active LCDs
L35000
MoPath: Molecular Pathology Procedures
L33615
Lower Extremity Major Joint Replacements
L33631
Outpatient Physical Therapy, OT, and SLP
L33583
Non-Invasive Cardiac Imaging (SPECT, PET, Stress Echo)
Regional Billing Nuances & Compliance Safeguards:
New York eMedNY Crossover & Downstate GPCI Differentials: NYC/Long Island (Locality 01/02) vs Upstate (Locality 99) GPCI variations. Secondary claims route automatically to eMedNY with Category of Service (COS) validation.
MassHealth (MA) & CT HUSKY Health Coordination: Electronic attachments transmitted via Provider Online Service Center (POSC).
Outpatient therapy follows Jimmo v. Sebelius maintenance therapy compliance and KX modifier threshold tracking.
Mandatory single-use drug vial wastage recording with JW/JZ modifiers.
Healthcare Locations & Cities in Rhode Island
Select your city below for specialized local medical billing solutions and regional payer expertise.