EOHHS Medicaid Managed Care Organization (MCO) Requirements for Medicaid Member Demographic Changes
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Governance of how contracted MCOs and vendors may accept and report Medicaid member address, phone, and email changes to EOHHS; applies to non-institutional members and EOHHS-contracted vendors/MCOs.
No material clinical or coverage changes in this revision.
Vendor Reporting and Handling Requirements
Vendor reporting and handling criteria
Procedural criteria vendors and MCOs must follow when accepting and reporting member demographic changes using the approved template and FTP process. Covered when ALL of the following are met:
Exception Codes and Submission Limits
| E01 | Individual is not found in RIBridges system |
| E02 | Case is not found with individual as head of household |
| E03 | All cases with the individual as head of household don't have authorized and ongoing benefits for any program |
| E04 | The information in the Excel is incomplete |
| E06 | City in RI physical address is not among the 39 allowed values |
| E07 | Individual is a head of household for a MA-SSI case |
| E08 | None of the cases have ongoing Medicaid benefits |
| E09 | The format of one or more values in the Excel is incorrect |
Consent, Verification, and Preferred Reporting Channels
Obtain affirmative permission and verify caller authority on recorded calls
Vendors must obtain the member’s affirmative permission before forwarding demographic changes to EOHHS; ask the permission question as an affirmative yes/no on recorded calls. If the member refuses permission, the vendor may update internal records but must not forward the change to EOHHS. Vendors must verify caller authority: for RIte Care confirm the caller is the Medicaid head of household; for Expansion, RHP, and FIDE SNP confirm the caller is the Head of Household or has power of attorney. Vendors must not accept prospective address changes or accept changes for SSI members (SSI members must be instructed to report changes directly to SSA).
- Ask for permission as an affirmative yes/no on the recorded call.
- If permission denied, update only internal records; do not forward to EOHHS.
- Verify authority: RIte Care = HOH; Expansion/RHP/FIDE SNP = HOH or POA.
- Do not accept prospective address changes.
- Do not accept demographic changes for SSI members; instruct to report to SSA.
Tell members the preferred reporting channels (HSRI portal or HSRI/DHS phone)
Inform members that the preferred way to report demographic changes is via the HSRI Customer Portal or by contacting HSRI/DHS; vendors may accept telephone updates only as an alternative. Provide HSRI and DHS contact options when advising members.
- Preferred: HSRI Customer Portal (link provided in policy) or HSRI phone (855-840-4774).
- Alternate: DHS phone 1-855-MY-RIDHS (1-855-697-4347).
- Telephone updates through the vendor are allowed only as an alternative to member self-reporting.
Key Terms and Exceptions
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