CurrentNeighborhood Health Plan of Rhode IslandPolicy N/A

Non-covered Claim Modifiers

This reimbursement policy lists specific claim modifiers that Neighborhood Health Plan of Rhode Island designates as non-covered for Medicaid, Commercial, and INTEGRITY claim types. It affects providers submitting claims to the payer.

Policy Summary

PayerNeighborhood Health Plan of Rhode Island

PolicyNon-covered Claim Modifiers

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionDo not append listed non-covered modifiers to claims for the indicated product types.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

~40modifiers explicitly marked non-covered for at least one product

3coverage columns shown

somemodifiers covered in at least one product

Modifier Coverage Overview

Modifier coverage table

The table below lists claim modifiers and indicates whether each modifier is non‑covered (X) or covered (blank) for the specified product columns.

Policy Summary

PayerNeighborhood Health Plan of Rhode Island

PolicyNon-covered Claim Modifiers

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionDo not append listed non-covered modifiers to claims for the indicated product types.

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.

ALL of the following

Modifier
- 21 — Medicaid: X; Commercial: X; INTEGRITY: (blank)
- EY — Medicaid: X; Commercial: X; INTEGRITY: X
- GC — Medicaid: X; Commercial: X; INTEGRITY: (blank)
- GL — Medicaid: X; Commercial: X; INTEGRITY: X
- GY — Medicaid: (blank); Commercial: X; INTEGRITY: X
- HU — Medicaid: X; Commercial: X; INTEGRITY: X
- HV — Medicaid: X; Commercial: X; INTEGRITY: X
- HW — Medicaid: X; Commercial: X; INTEGRITY: X
- HX — Medicaid: X; Commercial: X; INTEGRITY: X
- HY — Medicaid: X; Commercial: X; INTEGRITY: X
- HZ — Medicaid: X; Commercial: X; INTEGRITY: X
- J1 — Medicaid: X; Commercial: X; INTEGRITY: X
- J2 — Medicaid: X; Commercial: X; INTEGRITY: X
- J3 — Medicaid: X; Commercial: X; INTEGRITY: X
- MS — Medicaid: X; Commercial: X; INTEGRITY: X
- P6 — Medicaid: X; Commercial: X; INTEGRITY: X
- Q2 — Medicaid: X; Commercial: X; INTEGRITY: X
- Q5 — Medicaid: X; Commercial: X; INTEGRITY: X
- Q6 — Medicaid: X; Commercial: X; INTEGRITY: X
- QJ — Medicaid: X; Commercial: X; INTEGRITY: X
- QR — Medicaid: X; Commercial: X; INTEGRITY: X
- SV — Medicaid: X; Commercial: X; INTEGRITY: X
- TK — Medicaid: X; Commercial: X; INTEGRITY: X
- TR — Medicaid: X; Commercial: X; INTEGRITY: X
- ZZ — Medicaid: (blank); Commercial: X; INTEGRITY: X

Listed Non-Covered Modifiers and Legend

Listed non-covered modifiersModifierNot Covered

21	Modifier 21 — Medicaid = X; Commercial = X; INTEGRITY = (blank)
EY	Modifier EY — Medicaid = X; Commercial = X; INTEGRITY = X
GC	Modifier GC — Medicaid = X; Commercial = X; INTEGRITY = (blank)
GL	Modifier GL — Medicaid = X; Commercial = X; INTEGRITY = X
GY	Modifier GY — Medicaid = (blank); Commercial = X; INTEGRITY = X
HU	Modifier HU — Medicaid = X; Commercial = X; INTEGRITY = X
HV	Modifier HV — Medicaid = X; Commercial = X; INTEGRITY = X
HW	Modifier HW — Medicaid = X; Commercial = X; INTEGRITY = X
HX	Modifier HX — Medicaid = X; Commercial = X; INTEGRITY = X
HY	Modifier HY — Medicaid = X; Commercial = X; INTEGRITY = X

1–10 of 25

1/3

Non-Covered Modifier Marker

Non-covered markerX = Non-Covered; blank = Covered

Marker meaningAn 'X' placed in a product column indicates that the modifier is not covered for that product

Blank meaningA blank product column indicates the modifier is covered for that product

Billing Guidance for Providers

Billing Rule

Do not append modifiers marked 'X' to claims

Providers should not append listed non-covered modifiers to claims for the indicated product types. An 'X' in the table indicates the modifier is non-covered for that product column; a blank indicates the modifier is covered.

Do not append modifiers marked with an 'X' for the applicable product (Medicaid, Commercial, INTEGRITY).
If a modifier column is blank, the modifier is considered covered for that product and may be appended per usual billing practices.

OpenPayer

Non-covered Claim Modifiers

Modifier Coverage Overview

Listed Non-Covered Modifiers and Legend

Billing Guidance for Providers

Modifier Indicator Definitions