Providers may request to have an adjustment made to a previously processed claim for reasons such as, but not limited to, coordination of benefits or payment modifications and timely filing (TF) denials.
Request for Single Claim Adjustment
Adjustment requests for singular claims can be submitted electronically via web-based electronic forms (eForm). Adjustment requests require the submission of a completed Adjustment Request eForm, applicable claim number, and Remittance Advice, Explanation of Benefits, and/or Coordination of Benefits documentation, as applicable.
Select a plan below to initiate the adjustment request process for a single claim:
- INTEGRITY (Medicare-Medicaid Plan) / Commercial Plans
- ACCESS (RIte Care) / TRUST(Rhody Health Partners)
Request for Multiple Claim Adjustments
For larger provider groups, it may be necessary to request an adjustment on multiple claims. Adjustment requests for multiple claims (up to fifty) can be made by downloading and emailing the Neighborhood Claim Adjustment Grid. Neighborhood uses the Claim Adjustment Grid to review the information submitted in each row and respond to each issue via the “Final Outcome” column of the grid.
Please see below for more information and guidance, including what to expect after you submit a Claim Adjustment Grid.
Submitting a Claim Adjustment Grid
- Click here to access the Neighborhood Claim Adjustment Grid (Google Chrome is the recommended web browser).
- Download the grid to your computer and save it before data is added, otherwise changes will not be saved.
- Instructions are on the grid, but please ensure all fields are complete, including the submitter’s information. The last column, “Final Outcome,” is for Neighborhood use only.
- Submit the completed grid (no attachments) via secure e-mail to Neighborhood at: ClaimResubmission@nhpri.org
Please note that the Claim Adjustment Grid process is for adjustment requests only. Providers can use NaviNet to look-up the status of a claim.
After Your Claim Adjustment Grid Submission
Once you submit a Claim Adjustment Grid, Neighborhood will confirm receipt via email within 48 hours. The email acknowledgement will include a Neighborhood Issue ID for reference, as well as, an estimated completion date.
- Completed grids will be returned to the submitter via secure email with the “Final Outcome” column updated within 30 calendar days from the acknowledgement email date.
If Neighborhood is unable to process a Claim Adjustment Grid, the submitter will be notified via email within 48 hours. The email will include a Neighborhood Issue ID for reference and the reason(s) for rejection (e.g., incomplete and/or missing data information, incorrect format). Submitters should address the rejection concerns and submit again via the process above.
Questions and Clarification
If your Claim Adjustment Grid does not get returned according to the timeframe above, please email ClaimResubmission@nhpri.org and include the Neighborhood Issue ID for reference in the subject line.
For all other questions, please call Neighborhood Provider Services at 1-800-963-1001.