Rhode Island Medical Billing From Our North Smithfield Office
Prospect Healthcare Solutions provides medical billing and coding for Rhode Island practices from our office in North Smithfield. We handle claims, denials, accounts receivable and credentialing for solo physicians, group practices and clinics across the state, so your team can focus on patients.
Our office: 21 Sayles Hill Rd Unit 1, North Smithfield, RI 02896. Call +1 (469) 935-4617 or request a free quote.
Medical Billing and Coding in Rhode Island
Our certified coders and billers handle the full claim, from charge entry to payment:
- Medical coding: CPT, HCPCS and ICD-10 codes assigned from your documentation, with modifiers checked before the claim goes out.
- Claim submission: clean claims sent electronically to each payer, with rejections fixed the same day they come back.
- Payment posting: payments and adjustments posted from every remittance, so balances stay accurate.
- Denial management: every denial worked by its reason code, then corrected, resubmitted or appealed. See our denial management services.
- Accounts receivable: unpaid claims followed up until they are paid or resolved. See our accounts receivable services.
- Credentialing: enrollment with Rhode Island payers for new providers and new locations. See our credentialing services.
Outsourced Medical Billing for Rhode Island Practices
Outsourcing your billing gives you a full billing team without hiring, training or covering staff absences. We work in your practice management system or ours, follow your workflows, and send regular reports on collections, denials and outstanding claims.
Practices usually outsource when:
- A biller leaves and claims start to back up
- Denials or unpaid claims are growing faster than staff can work them
- The practice is adding providers or locations and needs them enrolled and billing quickly
- Owners want clear reporting on where revenue is being lost
See how we support small practices and our full revenue cycle management service.
Rhode Island Payers We Work With
Rhode Island practices bill a small set of payers with their own rules. We bill all of them and track each one’s filing limits, authorization rules and edits.
- Medicare: Rhode Island Part A and Part B claims are processed by National Government Services, the Medicare contractor for Jurisdiction K (New England and New York).
- Rhode Island Medicaid (RIte Care and other programs): managed care is run by Neighborhood Health Plan of Rhode Island and UnitedHealthcare Community Plan under contracts that started July 1, 2025.
- Commercial plans: including Blue Cross & Blue Shield of Rhode Island and national carriers.
We confirm eligibility and benefits before each visit, so claims go to the right plan the first time.
Rural Health Clinic Billing
Rural Health Clinics bill Medicare differently from physician offices. Visits go on the institutional claim (UB-04, type of bill 71X) with RHC revenue codes, and Medicare pays an all-inclusive rate per qualifying visit rather than per service.
We set up RHC claims correctly, separate billable visits from services included in the rate, and bill commercial and Medicaid plans under their own rules. Learn more about the UB-04 form.
Specialties We Bill For in Rhode Island
We bill for more than 50 specialties. Among them:
- Family practice and internal medicine
- Behavioral health and mental health
- Cardiology
- Physical therapy and chiropractic
- Urgent care
- Laboratory
See all specialties.
Rhode Island Medical Billing FAQs
Do you have an office in Rhode Island?
Yes. Our office is at 21 Sayles Hill Rd Unit 1, North Smithfield, RI 02896, and we serve practices across the state.
Do you bill Rhode Island Medicaid plans?
Yes. We bill Neighborhood Health Plan of Rhode Island, UnitedHealthcare Community Plan and Medicaid fee-for-service, and track each plan’s authorization and filing rules.
Who processes Medicare claims for Rhode Island practices?
National Government Services, the Medicare contractor for Jurisdiction K, processes Part A and Part B claims for Rhode Island.
Can you take over billing from our current biller or company?
Yes. We work through a handover plan: open claims, unpaid AR, payer enrollments and system access, so billing continues without a gap.
Do you bill for Rural Health Clinics?
Yes. We bill RHC visits on the institutional claim at the all-inclusive rate, and bill other payers under their own rules.
Talk to a Rhode Island Billing Team
Tell us about your practice and we'll send a free quote and a plan for taking over your billing.
Prefer to talk? Call +1 (469) 935-4617 or visit our contact page.