CurrentNeighborhood Health Plan of Rhode IslandPolicy N/A

Reinstatement of PCP Requirement for Select Services

This document governs Neighborhood Health Plan of Rhode Island's reinstatement of pre‑pandemic requirements that specified services must be provided by a member's assigned primary care provider (PCP) and affects Medicaid and Commercial members and their providers.

Policy Summary

PayerNeighborhood Health Plan of Rhode Island

PolicyReinstatement of PCP Requirement for Select Services

Policy CodePolicy N/A

Change TypeReinstatement of pre-pandemic PCP service requirements

Effective DateMar 1, 2024

Next Review DateN/A

Key ActionVerify member has an assigned PCP or a covering PCP in your practice; claims from non-assigned providers will be denied.

SourceLink

POLICY UPDATE CHANGES

Neighborhood will revert to pre-pandemic requirements concerning primary care services; requirements initially lifted April 1, 2020 are being reinstated effective March 1, 2024.

2024-03-01date change takes effect

8services requiring assigned PCP

1-800-963-1001Provider Services contact

Services That Must Be Provided by Assigned PCP

Coding and Effective Date

Policy Summary

PayerNeighborhood Health Plan of Rhode Island

PolicyReinstatement of PCP Requirement for Select Services

Policy CodePolicy N/A

Change TypeReinstatement of pre-pandemic PCP service requirements

Effective DateMar 1, 2024

Next Review DateN/A

Key ActionVerify member has an assigned PCP or a covering PCP in your practice; claims from non-assigned providers will be denied.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Verification and Claim Guidance for Providers

Denial Risk

PCP Assignment Verification and Claim Denial Guidance

Verify that Neighborhood Health Plan of Rhode Island members have an assigned PCP or an approved covering PCP within your practice before rendering services. Claims for services provided by a PCP who is not the member's assigned PCP or an approved covering PCP may be denied with the adjudication message: "Service Must Be Rendered by Member's PCP."

If the member wishes to designate a PCP within your practice, complete the PCP Change Form or instruct the member to contact Member Services to request the change.
If you believe services were rendered appropriately by an assigned or covering PCP but a claim was denied, contact Provider Services for assistance and to initiate claim review.

OpenPayer

Reinstatement of PCP Requirement for Select Services

Services That Must Be Provided by Assigned PCP

Coding and Effective Date

Verification and Claim Guidance for Providers

Key Definitions