Professional Revenue Cycle Management in Rhode Island
Mediknocx manages the revenue cycle for Rhode Island practices from the first eligibility check to the final payment. We're built around the payers you bill most: Blue Cross & Blue Shield of Rhode Island (BCBSRI), the state's largest health insurer, and Rhode Island Medicaid, with its 365-day filing window and three managed care plans.
HIPAA Compliant
Your data stays secure
Faster Payments & Fewer Denials
Improve cash flow
Higher Reimbursement
Get the revenue you deserve
Rhode Island Billing Compliance Experts
State-specific payer knowledge
Get Your Free Revenue Assessment
Find out how much revenue your practice could be recovering with expert revenue cycle management support. No obligation, just real insights.
Professional Revenue Cycle Management in Rhode Island: Prompt Pay Protection Starts With Filing Inside 90 Days
Rhode Island's prompt pay law (R.I. Gen. Laws § 27-18-61) requires health plans to pay complete claims within 30 days of receiving an electronic claim or 40 days for a paper one. Late payments accrue 12% annual interest. The catch: that protection doesn't cover claims first submitted more than 90 days after the date of service.
The front end changed too. The Rhode Island Prior Authorization Reform Act of 2025 runs a pilot from October 1, 2025 through October 1, 2028 that bars insurers from requiring prior authorization for services ordered by an in-network primary care provider. Prescription drugs are excluded. We check each order against the pilot so you don't chase authorizations you no longer need, or skip ones a payer still requires.
Expertise
Built for local care models
Deadline Tracking
We flag at-risk claims early
Fewer Denials
Correct coding, less revenue loss
The Full Revenue Cycle We Manage in Rhode Island
- Patient Access & Eligibility Verification: Confirm coverage before the visit, identify the member's Medicaid plan, and capture the 10-digit Medicaid ID.
- Charge Capture & Coding: Certified coders match CPT, ICD-10-CM, and HCPCS codes to documentation.
- Claims Submission: Clean electronic claims keep you on the 30-day prompt pay clock.
- Payment Posting: ERAs are checked against contracted rates; late payments are flagged for interest.
- Denial Management & Appeals: Plans must explain a denial within 30 days. We correct and resubmit fast.
- AR Follow-Up: Aging claims are worked by payer, including Medicaid's 90-day exception windows.
- Reporting: Monthly performance reports on collections, denials, and AR days.
How It Works
From Audit toFaster Payments in 4 Steps
A simple, proven process to streamline your revenue cycle and maximize reimbursements in Rhode Island.
Free Audit
We review your claims, denials, and AR aging.
Custom Plan
A written plan built for your payer mix.
Seamless Transition
We connect to your system with no gap in claims.
Ongoing Reporting
Monthly reports show exactly where your revenue stands.
Get Your FreeRevenue Cycle Audit Report
Losing money between the visit and the deposit? Call +1 434-201-9720 or email info@mediknocx.com for a free revenue cycle audit.
What Makes Our Rhode Island
Revenue Cycle Management Different
One team owns every stage of your cycle, not just claim submission.
Full-Cycle Ownership
One team handles eligibility, coding, claims, posting, denials, and AR, so problems found downstream get fixed at the source instead of repeating month after month across your claims.
BCBSRI and MCO Focus
We work the payer rules that shape Rhode Island revenue, including BCBSRI policies and the separate billing requirements of each of the state's three Medicaid managed care plans.
Timely Filing Tracking
Every open claim is tracked against its own deadline, from the 90-day prompt pay window to Medicaid's 365-day limit and its exception windows, so eligible revenue never ages out unnoticed.
Monthly Reporting Cadence
You receive a clear monthly report on collections, denial rates, and AR days by payer, with plain notes on what changed since last month and which actions we're taking next.
Compliance Built In
Our workflows follow HIPAA requirements, the No Surprises Act, and Rhode Island payer rules, and we update them whenever state law, OHIC regulation, or a payer's published policy changes.
Specialty Depth
Coders assigned to your specialty know its code sets, so they catch modifier errors and bundling issues that general billers often miss, which keeps more claims clean on the first pass.
Specialty Expertise That Works for You
Mediknocx supports revenue cycle management for 47 medical specialties, including family practice, internal medicine, cardiology, behavioral health, orthopedics, pediatrics, OB-GYN, and pain management. Team members are assigned by specialty.
How Does Mediknocx Ensure Compliance
With Rhode Island Medical Billing Regulations?
No Surprises Act
Good faith estimates and balance billing limits are applied for self-pay and out-of-network patients.
Rhode Island Timely Filing Law
Rhode Island Medicaid claims must reach Gainwell Technologies within 365 days of service, and commercial claims are filed fast enough to keep state prompt pay protection.
Rhode Island Billing Transparency & Itemization
Patient statements are itemized. For facility-based care, R.I. Gen. Laws § 23-17-19.1 guarantees an itemized bill on request.
Payer-Specific Guidelines
We follow the published policies of BCBSRI, Neighborhood Health Plan of Rhode Island, Tufts Health RITogether, UnitedHealthcare Community Plan, and Medicare.
Healthcare Billing Services Across Rhode Island Cities
We serve healthcare providers in Providence, Cranston, Warwick, and across the state.
- Providence
- Warwick
- Cranston
- Pawtucket
- East Providence
Nationwide Revenue Cycle Management
Mediknocx also supports practices in Delaware, Florida, Georgia, Hawaii, Illinois, Indiana, New Mexico, New York, South Carolina, and Utah.
Ready for a revenue cycle that runs on schedule? Start with a free audit from our Rhode Island RCM team. Reach us at +1 434-201-9720 or info@mediknocx.com.
Frequently Asked Questions
Find answers to the most common questions about our revenue cycle management services in Rhode Island.
