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  • 1-855-838-1370
  • 445 Main Street, 2nd Floor, #1, Saco, ME 04072
  • Mon to Fri 9:00AM to 06:00PM EST
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Shoreline Healthcare Technologies is a proud Maine-based  company that offers end to end revenue cycle management services to physicians and Medical billing companies in   in Rhode Island. Our goal is to help them manage their business in a way where they can focus on patient care and operations, not paperwork! By providing great services at reduced costs, we have been able to keep our customers since our inception in 2015. Explore our case studies to see how we’ve helped practices overcome complex billing challenges and improve cash flow.

As a medical billing outsourcing company, we have helped our clients grow their business by providing them with the resources they need to succeed while maintaining a competitive edge in today’s industry. We offer timesaving, cost-effective revenue cycle management services to your Rhode Island-based practice.  Ready to outsource your billing needs? We’ll guide you through your receivable account to make sure that your claims are paid.

Best In the Industry

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Shoreline Healthcare Technologies in Rhode Island exceeds customer expectations and we are proud of our history, but more importantly we are focused on the future. We have grown in recent years by continuing to invest in technology and people while maintaining a commitment to excellent service and innovation. We have the best customer service and one of the highest success rates for reimbursement, so you know your money will be going where it belongs - back into your pocket.

Rhode Island Billing Challenges we solve



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MCO-Specific Billing Rules for NHPRI and Other Plans


A significant portion of Medicaid members in the state are enrolled with the Neighborhood Health Plan of Rhode Island, resulting in higher exposure to single-payer payment delays, operational risk when even a small rule changes can disrupt the cash flow statewide. At Shoreline Healthcare Technologies we maintain a dedicated payer rule libraries for NHPRI and other RI MCOs and continuously monitor the changes in authorization rules, modifiers, and other coverage details. All claims are scrubbed electronically as per the payer logic before submission. This has resulted in higher clean-claim rates and protection against sudden payment slowdowns caused by silent payer edit changes.

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Behavioral Health and Medical Billing Alignment


The Rhode Island has carved out the behavioral health services from the general medical billing creating a separate authorization workflow, different coding and modifier rules and documentation conflicts for integrated care providers. Integrated clinics frequently experience denials when behavioral health services are billed alongside medical E&M services even when it is clinically appropriate. At Shoreline we apply the correct service sequencing and modifier strategies that comply with the RI carve-outs, our documentations are aligned to both medical and behavioral health standards and follow payer-specific guidance for same-day and co-occurring services. This prevents the avoidable denials for clinically appropriate care and stabilizes reimbursement for integrated practices.

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Closing the Medicaid Support Gap for Providers


Unlike larger states, Rhode Island Medicaid and its MCOs offer fewer provider education sessions with limited written clarification for complex denials. This creates risk for smaller practices without a dedicated Medicaid specialist. Shoreline Healthcare Technologies acts as an extension of your team and provides you with a dedicated RI-trained billing specialists who already understand payer nuances. By monitoring daily, we catch the denial trends early, and provide clear, actionable guidance to keeps the claims compliant and moving. The result is fewer delays, lower risk, and steadier cash flow even for smaller practices without in-house Medicaid experts.

We at Shoreline Healthcare Technologies provide personalized support tailored to the unique needs of Rhode Island providers. Our team of experts understands the intricacies of the Rhode Island billing landscape and offers guidance to help practices navigate these challenges effectively with our cloud-based RCM solutions for an optimized Revenue Cycle Management.

Comprehensive Medical Billing Services for Rhode Island

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Specialized Services tailored to meet Rhode Island Medicaid rules and regulations

🩺 Services 📍Rhode Island Specialization 📈 Typical Improvement ⏱️ Turnaround Time
End-to-End Medical Billing Full alignment with Rhode Island Medicaid billing rules and MCO requirements 25–40% reduction in denial rates with faster reimbursement cycles. Claims submitted within 24–48 hours
Eligibility & Coverage Verification Daily eligibility checks across FFS and MCO plans; detection of retroactive eligibility and coverage flips. 15–30% drop in eligibility-related denials Instant/ Within 24 hours
Prior Authorization Management PA workflows aligned to RI Medicaid program categories 40–60% reduction in PA-related denials 3–5 business days
MCO-Specific Claims Management Dedicated handling for NHPRI and other RI MCOs with payer-specific edits Faster reimbursements and fewer rejections 24–72 hours from charge entry
Behavioral Health Billing Support Integrated medical & behavioral health billing aligned to RI carve-out rules Reduced write-offs for co-occurring services Continuous, claim-based
Denial Management AI based tools to track and flag denial codes and root-cause analysis tailored for Medicaid claim categories, identifies high-risk categories and automate resubmissions. Reduce rate of denial by 75% and with quicker appeals. 7–14 days for backlog cleanup; ongoing daily follow-up
Patient Statements & Follow-Up Communicate with patients and give Explanation of Benefits (EOBs). Includes text/email payment reminders and online payment options. Reduces overdue balances and increases the collection rates. 1-2 weeks
Audit & Compliance Support Conducts Audit Review and mock audits, including documentation, encounter verification, and claim reconciliation. Minimizes risk of penalties and supports successful audits. Ongoing, depending on audit schedule

Medical Billing Resources for Rhode Island

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Comprehensive resources specifically designed for Medicaid Providers to navigate the state’s complex Billing Landscape.

Medicaid Billing Guide

A Complete guide covering all billing requirements, policy updates and compliance standards.

Behavioral & Mental Health Billing rules and guidelines

Specialized billing guidelines and documentation procedures for behavioral health programs.

Revenue Cycle Optimization

Best Practices and Strategies to improve cash flow and reduce denials.

Telehealth and Remote patient Monitoring in Rhode Island

Rhode Island’s telehealth and RPM guidelines and regulations.

Serving Healthcare Providers Across Rhode Island

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From Adams to York, we provide comprehensive medical billing services across all 5 Rhode Island counties.

South Carolina Map
The Urban Core:

Providence County

The West Bay:

Kent County

South County:

Washington County

The East Bay:

Bristol County

The Islands:

Newport County

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Primary Care
Specialty Clinic
Rural Health
Mental Health
Cardiology
Dermatology
Emergency Medicine
Family Medicine
Internal Medicine
Neurology
Oncology
Orthopedics
Pediatrics
Psychiatry
Radiology
Surgery
Urgent Care
Women's Health

Frequently Asked Questions

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FAQs about Medical Billing Services in Rhode Island

Q1. Why are prior authorizations especially challenging in Rhode Island?

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Prior authorization rules in the state are often program-driven not CPT-based. The same service may require authorization under one Medicaid program but not in the case of another, this increases the risk of retroactive denials.

Q2. What types of providers are benefitted the most from Shoreline’s services?

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Shoreline Healthcare Technologies renders support to all types of practices from Primary care, behavioral health clinics, CCBHCs, integrated care organizations, and Medicaid-heavy specialty providers. We provide state–specific billing support along with customized revenue cycle management that fulfils the requirements of every specialty irrespective of their practice size.

Q3. How does Shoreline prioritize A/R follow-up for Medicaid claims?

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At Shoreline Healthcare Technologies claims are segmented by payer type (FFS vs MCO), denial reason, and dollar value. So that high-risk and high-value claims are prioritized and worked first to accelerate the cash flow.

Q4. What are the initial processes that Shoreline does on onboarding?

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  • ➣ Reviews current billing workflows and denial patterns
  • ➣ Confirms Rhode Island Medicaid and MCO enrollment status
  • ➣ Sets up payer-specific claim rules and authorization workflows
  • ➣ Transits claims without disrupting the cash flow

Providers can see an increase in clean claim submission within the first few weeks of onboarding, with measurable performance improvements by partnering with Shoreline Healthcare Technologies

Q5. What are the factors that influences the process of onboarding?

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  • ➣ Active status of the provider with Rhode Island Medicaid and other MCOs
  • ➣ Data access (EHR, clearinghouse, payer portals)
  • ➣ Volume of legacy A/R and denied claims
  • ➣ Scope of services (full RCM vs. partial support)

Q6. How can Shoreline Healthcare Technologies help providers in Rhode Island?

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We at Shoreline Healthcare Technologies handle the entire process of RCM Cycle from patient appointment scheduling to eligibility checks, prior auths, coding, claim submissions, denials, and appeals, till payment processing and patient communication ensuring faster payments and compliance with state specific rules. We also offer analytics and process automation to reduce first pass rejects in state systems and to reconcile managed-care encounter reporting.

Compliance & Certifications

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Your data security and compliance are our top priorities.

HIPAA Compliant

Full HIPAA compliance with regular audits

AAPC Certified

Certified Professional Billing Staffs.

Rhode Island Licensed

Licensed to operate in Rhode Island

Medical Billing Glossary

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Essential Terms for Understanding the Rhode Island’s Medical Billing Landscape

Certified Community Behavioral Health Clinics (CCBHCs)

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The specially designated clinics for providing comprehensive behavioral health services to Medicaid and uninsured populations of the state of Rhode Island.

Executive Office of Health and Human Services (EOHHS)

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The agency in the state of Rhode Island that oversees the Medicaid program. It is responsible for setting the policy rules, issuing the guidance for the providers, and contracting with the MCOs.

HealthyRhode mobile app

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The mobile application used by the Medicaid members in the state of Rhode Island to manage their benefits, upload documents, receive eligibility notifications, and complete renewal processes.

Neighborhood Health Plan of Rhode Island (NHPRI)

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It is the largest Medicaid Managed Care Organization in Rhode Island. It administers claims, prior authorizations, and provider payments for a significant portion of Medicaid members.

StayCovered

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An initiative for helping the members in the state of Rhode Island to maintain their coverage status continuously even during the renewals and eligibility redeterminations periods thereby reducing the gaps that would otherwise lead to claim denials and retroactive eligibility issues.

Our Services

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Shoreline proudly supports physicians, medical groups, and medical billing companies. Following are the revenue cycle management steps we offer.

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Testimonials

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We Care

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From electronic health records, billing services and practice management tools-Shoreline has you covered! In addition to being industry leader when it comes to pricing, we also provide personalized support for every client, with a team of experts who have worked with physicians and medical groups for years, Shoreline Healthcare Technologies in Rhode Island understands how to navigate today’s complex healthcare revenue environment.

Ready to Optimize Your Medical Billing?

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Get your free consultation and discover how much you could save with our Rhode Island-specialized billing services.

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Contact Information

  • 445 Main Street, 2nd Floor, #1, Saco, ME 04072
  • 1-855-838-1370
  • info@shorelinemb.com
  • M-F, 9am - 5pm EST

Why work with us?
  • 40% average denial rate reduction
  • Local billing expertise
  • 24-48 hour claim turnaround
  • Dedicated Rhode Island support team