Credentialing in Rhode Island
Soft Home Global provides payer enrollment, revalidation and follow-up for Rhode Island practices and billing companies at $2,250 per seat per month. Full time, worked during Rhode Island business hours, inside your own system.
What is specific to Rhode Island
Most Rhode Island Medicaid members receive benefits through managed care plans under the RIte Care umbrella, and the state's small commercial market is concentrated among a handful of insurers.
Rhode Island’s Medicaid programme is Rhode Island Medicaid. Practices with a meaningful Rhode Island Medicaid mix usually need it worked as its own queue rather than mixed into commercial follow-up, because the submission path, the timely filing window and the appeal route are all different.
What a credentialing seat does in Rhode Island
Applications, revalidations and payer follow-up, with every enrollment's status visible.
Rhode Island Medicaid is not one enrollment but one per plan, and every one of them has a revalidation date that stops payment when it passes. That calendar is the work.
- Initial applications prepared and submitted
- Revalidations tracked ahead of the deadline
- CAQH kept current
- Payer follow-up until an effective date is issued
- Status of every enrollment visible to you
- Worked during Rhode Island business hours, not queued overnight
For the statute behind all of this — Rhode Island’s prompt-pay deadline, its Medicaid filing limit, and the wrinkle that catches people out here — see the Rhode Island billing page.
Rhode Island Medicaid, in practice
Mandatory Medicaid managed care, delivered through RIte Care (parents/caretakers, pregnant women, children, foster children) and Rhody Health Partners (adults 19-64 without dependent children): "Participation in managed care is mandatory for the members of the MACC, non-MAGI and non-Medicaid funded coverage groups identified in § 2.1 of this Part except as specified in § 2.34 of this Part." The regulation does not state how many MCOs are under contract. Source
Working Rhode Island hours
Rhode Island runs on Eastern time, 10 hours behind our floor in Rawalpindi. To be at a desk for your nine to five, the shift here runs 7pm to 3am, and 6pm to 2am once the clocks go forward. Pakistan does not observe daylight saving, so the shift moves on this side rather than yours.
That is the part that decides whether follow-up happens at all: a payer’s phone lines are open on Rhode Island hours and nobody else’s.
What it costs in Rhode Island
$2,250
Per seat, per month, in US dollars — $27,000 a year for one full-time person, forty hours a week, on Rhode Island hours. No annual contract, no percentage of collections, no setup fee and no software to buy. Seat prices across all roles in Rhode Island run $1,550 to $2,550; the full list is published.
That is the entire invoice. Run your own figures against a percentage vendor or a hire rather than take ours.
Getting started in Rhode Island
About a week from a signed agreement to a person working your queue, and that week of training on your workflow is not billed on top. The work happens in your own system under a login you issue, so there is nothing to migrate and nothing to install. The week, step by step, and what is signed before anyone has access.
Questions
Do you work with Rhode Island practices?
Yes. Rhode Island accounts are worked during Rhode Island office hours rather than queued overnight, because a payer's phone lines are open then and at no other time.
What is different about Rhode Island?
Most Rhode Island Medicaid members receive benefits through managed care plans under the RIte Care umbrella, and the state's small commercial market is concentrated among a handful of insurers.
When does a Rhode Island payer have to pay a clean claim?
30 calendar days for a complete (clean) electronic claim; 40 calendar days for a complete written claim. A claim sitting past that is not merely late, it is late against a statute, and the follow-up call changes from "when might this be paid" to "this passed your statutory window on a specific date".
How much does credentialing cost in Rhode Island?
$2,250 per seat per month — $27,000 a year for a full-time person, forty hours a week. Every seat price is published at softhomeglobal.com/pricing.
What hours will somebody actually be working our Rhode Island queue?
Rhode Island is on Eastern time, 10 hours behind Rawalpindi. The shift here runs 7pm to 3am so your seat is at a desk for your full working day, shifting to 6pm to 2am while daylight saving is in force — Pakistan does not observe it, so the change happens on our side.
Do you handle Rhode Island Medicaid as well as commercial payers?
Yes, and as its own queue rather than mixed into commercial follow-up. Rhode Island Medicaid has its own submission path, its own filing window and its own appeal route, and working it in the same worklist as commercial claims is how the deadlines get missed.
Is this a percentage of what you collect?
No — a flat monthly rate per seat, published at softhomeglobal.com/pricing. A percentage bills you most in your best month and points the vendor at the easy accounts.
What is the minimum commitment, and how quickly can somebody start?
One seat for one month, cancellable on thirty days notice, and about a week from a signed agreement to a person working your queue. The week of training is not billed. The steps are at softhomeglobal.com/how-it-works.
Is our patient data safe offshore?
A Business Associate Agreement is signed before anyone has access, and the work happens in your own system under a login you issue, so every action is attributable to a person in your audit trail. The controls are listed at softhomeglobal.com/security.
More for Rhode Island
Next step
One seat on your Rhode Island work
Twenty minutes on a call is enough to tell whether this fits. If it does not, I will say so.
Or write to ops@softhomeglobal.com