ModifiedNeighborhood Health Plan of Rhode IslandPolicy N/A

INTEGRITY product hospital reimbursement methodology

Defines changes to how Neighborhood Health Plan of Rhode Island reimburses hospitals for services provided to INTEGRITY members, affecting hospital providers paid under the INTEGRITY product for dates of service on or after October 1, 2018.

Policy Summary

PayerNeighborhood Health Plan of Rhode Island

PolicyINTEGRITY product hospital reimbursement methodology

Policy CodePolicy N/A

Change TypeRevised reimbursement methodology

Effective DateOct 1, 2018

Next Review Date

Key ActionHospitals will be contacted individually regarding next steps for repayment of overpayments resulting from the prior methodology.

SourceLink

POLICY UPDATE CHANGES

The INTEGRITY reimbursement methodology was updated to eliminate components of the hospital rate that Medicare continues to reimburse directly (e.g., IME), effective for dates of service on or after October 1, 2018.

Oct 1, 2018effective date for methodology change

1 payerNeighborhood is sole payer for INTEGRITY members

IMErate components eliminated from Neighborhood reimbursement

Notifiedhospitals will be contacted individually about repayment

INTEGRITY Product Reimbursement Criteria

Reimbursement stance for INTEGRITY product

Neighborhood will no longer reimburse certain hospital rate components for INTEGRITY members that are reimbursed directly by Medicare.

Neighborhood updated the INTEGRITY reimbursement methodology to eliminate components of the hospital rate that Medicare continues to reimburse directly (e.g., Indirect Medical Education [IME]), effective for dates of service on or after October 1, 2018.

This change applies to hospital providers paid under the INTEGRITY product; there are no additional changes to reimbursement rates for other Neighborhood products.

Neighborhood will contact hospitals individually to discuss next steps for repayment of overpayments resulting from the prior methodology.

Coding and Effective Date

Affected rate componentsmixed

No codes listed

Policy Summary

PayerNeighborhood Health Plan of Rhode Island

PolicyINTEGRITY product hospital reimbursement methodology

Policy CodePolicy N/A

Change TypeRevised reimbursement methodology

Effective DateOct 1, 2018

Next Review Date

Key ActionHospitals will be contacted individually regarding next steps for repayment of overpayments resulting from the prior methodology.

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.

OpenPayer

INTEGRITY product hospital reimbursement methodology

INTEGRITY Product Reimbursement Criteria

Coding and Effective Date

Repayment and Provider Next Steps

Definitions and Rate Components