CurrentNeighborhood Health Plan of Rhode IslandPolicy N/A

Telephone-only temporary telemedicine reimbursement

Temporary policy permitting reimbursement for specific telemedicine services delivered by telephone only during a declared Rhode Island state of emergency (or when Neighborhood elects to implement it), applicable to participating providers across Neighborhood Health Plan of Rhode Island lines of business.

Policy Summary

PayerNeighborhood Health Plan of Rhode Island

PolicyTelephone-only temporary telemedicine reimbursement

Policy CodePolicy N/A

Change TypeRevised (time-limited temporary policy)

Effective Date03/09/20

Next Review DateN/A

Key ActionDocument a permanent record of the telephonic communication, include POS 02 and modifier CR on claims, and submit claims within 90 days.

SourceLink

POLICY UPDATE CHANGES

Temporary allowance for specific telemedicine services to be provided by telephone only during a state of emergency or when Neighborhood elects to enact this policy.

90 daysclaim submission deadline

Commercial plansmember cost share waived

POS 02 + CRrequired claim indicators

99211, 99212example covered CPTs

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.

Telephone-only Telemedicine Coverage Criteria

Telephone-only telemedicine coverage criteria

Telemedicine services provided via telephone only are covered when ALL of the following are met and claims are billed correctly.

ALL of the following

The patient is present/participates at the time of service.
Services are of an amount and nature that would be sufficient to meet the key components and/or requirements of the same service when rendered via face-to-face interaction.
Services are medically necessary and otherwise covered under the member's benefit plan.
Services are within the provider's scope of license.
A permanent record of the telephonic communication(s) is documented and maintained as part of the patient’s medical record.
Telemedicine services provided via telephone only during a state of emergency or implementation of this policy by Neighborhood are limited to specified provider types (e.g., the member’s primary care physician).
Excluded services: those rendered through email, text, or fax; telemedicine that occurs the same day as a face-to-face visit by the same provider for the same condition; patient communications incidental to E&M services (e.g., test results, education); and administrative matters (e.g., scheduling, registration, reminders, medication refill requests, referral requests, ordering diagnostic studies, or patient-completed medical history intake).
Claims must be submitted within 90 days of the date of service; Place of Service (POS) 02 must be used to indicate telemedicine; claims for covered telephone-only telemedicine must include modifier 'CR' (Catastrophe/Disaster Related).

Example Codes and Claim Timing

Example covered E/M CPT codes for telephone-only telemedicineCPTCovered

99211	Office or other outpatient visit for evaluation and management of an established patient; minimal presenting problems; typically 5 minutes.
99212	Office or other outpatient E/M visit for established patient requiring 2 of 3 key components; typically 10 minutes.

Claim filing timeframe — deadline for submitting claims

Claim submission deadlineProviders must submit complete claims for payment within 90 days of the date services are provided to members.

Contractual applicabilityBillable services are subject to contractual agreements, when applicable.

Place of Service requirementTelemedicine is covered as a place of service; POS 02 must be on the claim to indicate telemedicine delivery.

Documentation, Audit, and Claim Submission Requirements

Documentation Required

Documentation, Audit, and Claim Submission Requirements

Providers must retain permanent, auditable documentation of telephonic telemedicine encounters in the member's medical record. Neighborhood may audit records to verify adherence to this policy, including confirmation the patient participated and that service content met the same key components required for an equivalent face-to-face visit. Providers are required to submit complete claims within 90 days of the date of service. Telemedicine services delivered via telephone during a declared state of emergency or under this policy must meet provider-type and coverage rules and be within the provider's scope of license.

Place of Service (POS) 02 must be included on the claim to indicate service delivered via telemedicine.
Claims for telemedicine services must include modifier 'CR' (Catastrophe/Disaster Related) when applicable.
Telemedicine is billed as the applicable service — it is not a distinct benefit; standard telemedicine reimbursement rules and contractual terms apply.
Maintain documentation showing the patient participated at the time of service, that services were medically necessary, sufficient in amount/nature to meet key components of the comparable in-person service, and within provider's scope of license.
Do not bill telemedicine for services rendered the same day as a face-to-face visit for the same condition by the same provider; communications incidental to E&M, administrative matters, and services via email/text/fax are excluded.

Key Definitions

Telephone-only telemedicine — definition and temporary allowance

DefinitionTelephone-only telemedicine: provision of telemedicine services exclusively via telephone (no video), temporarily permitted when the State of Rhode Island declares a state of emergency for a pandemic or when Neighborhood elects to enact this policy.

Relation to traditional telemedicineThis policy is separate from Neighborhood's traditional Telemedicine/Telehealth Services Policy, which requires a video component and secure electronic communication.

Scope and durationTemporary allowance during a declared state of emergency (or at Neighborhood's discretion); applicable to specific telemedicine services identified by the policy.

CR modifier — definition and usage note

Modifier meaningModifier 'CR' is defined as Catastrophe/Disaster Related.

Usage requirement