Frequently Asked Questions (FAQs)

Tufts Health RITogether

What is Tufts Health RITogether?

Tufts Health RITogether is our health plan for individuals eligible for the state’s Medicaid program. See Tufts Health RITogether benefits.

How do I become contracted as a Tufts Health RITogether provider?

If you are a provider interested in joining our network, the first step is to submit a formal letter of interest to the following address:  

Tufts Health Plan
Attn: Contract Manager
75 Fountain Street, Floor 1
Providence, RI 02903-1852

Learn more about joining our network.

How do my patients get information or enroll?
What are the eligibility requirements?

Adults, as well as children 18 and under, may be eligible. Individuals may qualify for Tufts Health RITogether if they meet one of the following criteria:

  1. Disabled according to the standards set by federal law, pregnant a parent or adult caregiver,  HIV-positive, or in treatment for breast or cervical cancer, or
  2. A Rhode Island resident who:
    • Is a U.S. citizen/national, qualified immigrant or lawfully present immigrant younger than 21, and
    • Is younger than 65 years old, and
    • Meets the income requirements for his or her age group
How will I know if my patient has Tufts Health RITogether?

Check your patient’s member ID card.

sample image of RITogether ID card
How much do Tufts Health RITogether members pay out-of-pocket?
  • They do not pay a premium (monthly bill)
  • They do not pay co-payments for services
  • They do not pay co-payments for medications
How will I know which providers are in- or out-of-network?

You can use our online Find a Doctor, Hospital or Pharmacy tool to search for in-network providers for Tufts Health RITogether. When searching for in-network providers, please remember that a yellow yield sign indicates the provider is a non-preferred in-network provider for whom we require prior authorization.

What benefits do Tufts Health RITogether members receive?
  • Tufts Health RITogether coverage includes office visits and screenings, access to thousands of medical and behavioral health specialists, X-rays and lab tests, treatment for mental health and substance use disorders, and prescription drug coverage.
  • You can see detailed information about covered benefits in our medical and behavioral health benefit summary grids.
  • Tufts Health RITogether members get all the benefits in our medical and behavioral health benefit summary grids.
What information about Tufts Health RITogether patients is available on Tufts Health Provider Connect?

The same patient information that is available for other Tufts Health Plan patients is available for Tufts Health RITogether patients on Tufts Health Provider Connect, including:

  • Prior authorization and claim status
  • Member information
  • PCP panel reports
  • Remittance advice

If you do not currently have a Tufts Health Provider Connect login, begin the sign-up process.

Does Tufts Health RITogether cover services rendered by out-of- network providers?

Tufts Health RITogether prefers that members see in-network providers. Out-of-network providers will require prior authorization.

Do I handle claims in the same way I currently do for other Tufts Health Plan products?

Yes. For more information on claims, log on to Tufts Health Provider Connect.

Do Explanations of Payment look the same?

Yes.

What information about Tufts Health RITogether members is available on Tufts Health Provider Connect?

You can find information on a member’s plan, eligibility and claim information.

What will happen to members who are in active treatment with an out-of-network provider?

If a member is seeing a provider who is not part of our network, our continuity of care policy may be able to cover some of his or her health services, including behavioral health (mental health and/or substance use disorder) services.

A member may be able to keep seeing the out-of-network provider in the following situations:

  • The provider is caring for a pregnancy and the member is in the second or third trimester of pregnancy, and the provider leaves the Tufts Health RITogether plan. The member may be able to keep seeing this provider through delivery.
  • The provider is actively treating a chronic or acute medical condition (with a treatment like dialysis, home health services, chemotherapy or radiation). The member may be able to keep seeing the provider for up to 30 calendar days.
  • The member is terminally ill or has significant health care needs or a complex medical condition, including serious or persistent mental illness. The member may be able to keep seeing the provider.
  • The individual became a Tufts Health RITogether member by changing from another Rhode Island Medicaid plan and has already begun treatment (such as ongoing maternity care) with a provider who does not contract with us. We will review that treatment and may approve the continued treatment by the same provider.

After the period of continuity of care ends, the member can continue to get care or treatment by choosing a Tufts Health RITogether in-network provider.

I have a question that isn’t answered here. Who should I contact?

You can call us at 844.301.4093 or check the online Provider Manual for more information.

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*Copies of this information can be made available upon request by calling the appropriate Tufts Health Plan Provider call center.

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