Billing NHP as a RI Doula
Billing NHP as a doula happens in a free online claims tool called Inovalon Link1500. Once your account is set up, every claim lives on one screen.
In our BCBSRI billing guide, we walked through submitting claims directly in Blue Cross's own provider portal. Neighborhood Health Plan of Rhode Island (NHP) works a little differently. Claims go through Inovalon, a separate claims service NHP sponsors for its providers at no cost to you.
There's a setup period up front, and a few boxes on the claim form that can feel strange the first time. This post walks through all of it, in order: signing up, checking your account, filling in the claim box by box, and copying your last claim for the next visit.
Before You Bill Anything: Get In-Network and Get Your Inovalon Account
Four things need to be in place before your first NHP claim: your state certification and NPI, enrollment with RI Medicaid, approval through NHP's own credentialing, and your own Inovalon Link1500 accoun
t.
Your RICB certification and NPI come first. You must hold a current Certified Perinatal Doula (CPD) credential from the Rhode Island Certification Board. A training organization certificate alone (DONA, BirthPro, or any other) isn't enough. You also need an active NPI, plus an NPI Type 2 if you bill as an LLC.
Next, enroll with RI Medicaid. Doula services are "in-plan" for RI Medicaid, which means you bill the member's health plan (like NHP) instead of the state. You still enroll with RI Medicaid first, through the RI Medicaid Healthcare Portal. During enrollment, choose the option for billing claims both directly to RI Medicaid and through a managed care plan. You'll need proof of your RICB certification, your NPI with taxonomy 374J00000X, your Tax ID (EIN or SSN), and a signed W-9.
Then NHP credentials you. NHP credentials birth and postpartum doulas the same way it credentials other providers. Part of that review is proof of liability insurance, and NHP accepts $1 million/$1 million coverage limits for doulas. Wait for your approval in writing before you see NHP members, since services provided before then won't be paid.
Then you set up Inovalon. This is where your claims actually get submitted.
The account is free for NHP providers. Sign up through NHP's sponsored form: Inovalon Sponsored Payer Request Form.
Most of the form is self-explanatory. These are the fields that can trip you up:
Form field | What to enter |
Title | Doula |
Organization | Your business name, or your own name if you work under it |
NPI | Your NPI |
Tax ID | The Tax ID NHP has linked to your NPI (your EIN, or your SSN if you bill under it) |
Insurance Payer Name | Neighborhood Health Plan of Rhode Island |
Taxable or Non-Profit? | Taxable, unless your practice is a registered nonprofit |
CMS 1500, UB-04 or both? | CMS 1500 |
Manual entry or batch upload (837)? | Manual entry |
Do you use a billing software? | No |
Credit card questions | Optional. These are about an add-on for collecting client payments. NHP pays you directly through your existing direct deposit, not through Inovalon |
What happens after you submit the form
An Inovalon rep calls you.
You get an email with a DocuSign agreement to sign.
About two weeks later, an email invite to the Inovalon portal arrives.
Plan for that gap. You can't submit claims until the invite shows up, so start the sign-up as soon as your NHP contract is in motion.
Keep these numbers handy
Item | Your value |
EIN or SSN (the Tax ID NHP has linked to your NPI) | |
NPI | |
Taxonomy | 374J00000X (Doula) |
NHP Provider Services | 1-800-963-1001 |
Check Your Setup Once, Before Your First Claim
Everything here lives under the Maintenance tab. One portal quirk first: the top menus (Link 1500, Maintenance) open when you hover over them, not when you click.
Physician / Organization. Your provider record may already exist when your account is created. Open it and confirm three things: your Tax ID (with EIN or SSN selected to match what NHP has on file), your NPI as the Rendering NPI, and taxonomy 374J00000X. No record yet? Click Add New and enter them yourself. The Tax ID is the one field you can't edit later, so take an extra second with it.
Favorite Insurance Companies. If Neighborhood isn't in your payer dropdown on the claim, search "Neighborhood," highlight it, and click the right arrow to add it to Favorites. If it shows up in red, it needs electronic enrollment first. Check Payer Enrollments on the portal dashboard.
With your record in place, starting a claim is three clicks: Link 1500, then Add a New Claim, then Neighborhood as the payer.
A note on member cards. If your client's card says "RHE," that stands for Rhody Health Expansion. That's NHP Medicaid. You still bill Neighborhood, and you still mark Box 1 as Medicaid.
The Codes: What to Bill and When
NHP uses two procedure codes for doula services. Prenatal and postpartum visits go under S9445, and the birth goes under 99199. The modifier is what tells NHP which kind of visit it was.
Visit type | Procedure code (Box 24D) | Modifier | Diagnosis code (Box 21A) |
Prenatal | S9445 | None | Z33.1 |
Labor and delivery | 99199 | None | Z37.0 |
Postpartum | S9445 | TH | Z39.2 |
A few things worth knowing about these:
Prenatal visits take no modifier. Leave the modifier field empty. (BCBSRI uses FP here, so this one is easy to mix up if you bill both.)
TH marks a postpartum visit. Without it, S9445 reads as a prenatal visit.
The birth has its own code. Bill 99199 once for labor and delivery, with no modifier.
Prenatal and postpartum visits share one limit: 6 visits per member, combined. You decide how to split them. Four prenatal and two postpartum works, and so does two and four.
The same codes apply across NHP plans. The standard NHP doula contract uses these codes for Medicaid, commercial (Exchange), and dual eligible plans. The walkthrough below follows a Medicaid claim.
Each visit has to last at least 60 minutes. Keep notes that show the date, the start and end time, and what you did together. RI Medicaid requires that documentation for every visit.
Home births aren't covered. RI Medicaid doesn't pay doulas to attend home births. Prenatal and postpartum visits in your client's home are still covered. If a client is planning a home birth, talk through this before the birth, so nobody is surprised by a denied claim afterward.
The state's own rules for the benefit, including the visit limits and documentation requirements, are in the RI Medicaid Doula Services Manual. That manual lists general Medicaid codes and says each health plan may set its own. The codes in the table above are the ones NHP uses.
Diagnosis Code vs. Diagnosis Pointer
These two boxes work together, and each one has its own job.
Box 21 holds the actual diagnosis code. Slot A gets the first diagnosis, for example Z33.1. Slots B through L are there if you ever need more than one code.
Box 24E holds a letter. Type A to say "this service line goes with the code in slot 21A."
If there's one code on the claim, the pointer is always A.
Think of Box 21 as a set of labeled shelves. The pointer tells NHP which shelf to look at.
Visit | Box 21A (code) | Box 24E (pointer) |
Prenatal | Z33.1 (pregnant state) | A |
Birth | Z37.0 (single live birth) | A |
Postpartum | Z39.2 (routine postpartum follow-up) | A |
If you also bill BCBSRI, you'll notice its diagnosis codes are different (Z34.90, O80 or O82, and Z39.0). Each payer sets its own, so use NHP's codes on NHP claims and BCBSRI's codes on BCBSRI claims.
Filling In the Claim, Box by Box
The claim screen times out after about 20 minutes. Have your client's member card and the visit details in front of you before you start.
Box | What to enter |
Payer (top) | Neighborhood, from the dropdown |
1 | Medicaid |
1a | Client's NHP member ID |
2, 3, 5 | Client's name, date of birth, sex, and address |
9 to 9D | Leave blank. These are only for a second insurance plan |
10A, B, C | All NO |
11 | Leave blank for Medicaid |
11A | Client's date of birth and sex |
11C | Optional: plan name from the card, such as RHE (it goes here, not in 9D) |
11D | NO |
12 | Check the box. Date = when your client signed your release |
13 | YES |
14 | Leave blank |
17 | Leave blank unless NHP requires a referring provider |
19, 20, 22, 23 | Leave blank (20 = NO). |
21A | Diagnosis code (see above) |
24A | Date of service, in both FROM and TO |
24B | Place of service: 12 home, 21 hospital, 25 birth center, 11 office, 10 telehealth |
24C | Leave blank |
24D | Procedure code and modifier (see the codes table above): S9445 with no modifier for prenatal, S9445 with TH for postpartum, 99199 with no modifier for the birth |
24E | A (the pointer) |
24F | Your charge for that code |
24G | Units, usually 1 |
24J | Fills in with your NPI once Box 25 is picked |
25 | Click the magnifying glass and pick your provider record. Double-check the Tax ID type |
26 | Optional: your own tracking number for this client |
27 | YES (required for Medicaid) |
28 | Fills in automatically |
29 | Leave blank or enter 0 |
Click Save. Anything missing turns yellow, and the panel on the right lists each error. Click an error to jump straight to the box that needs fixing. This is actually super helpful for making sure you don't miss anything.
Sending, Tracking, and Reusing Your Claims
Send it. Go to Home (Manage Pending Claims), click the claim row, click Transmit Selected, then OK. Write down the session number from the confirmation screen.
Check back in 1 to 2 days. Look at Session Results and the Rejection Center on the portal dashboard.
See what you were paid. Payment details (ERAs) are on the portal dashboard too.
Bill the next visit for the same client. Go to Manage Transmitted Claims, click Copy on the last claim, and change the date. If the visit type changed, update the code or diagnosis too. Then send.
That copy step is where the setup time pays off. After the first claim for a client, the rest go fast.
When a Claim Gets Rejected
A rejected claim shows up in the Rejection Center with the reason attached. Most rejections are fixable: open the claim, correct the box it points to, and resend.
Watch the deadlines. NHP has to receive a complete claim within 180 days of the date of service. A rejection notice doesn't count as proof you filed on time, so fix and resend rejected claims quickly. Corrected claims (a changed code, date, or modifier on a claim NHP already processed) can go in up to 365 days from the date of service.
Coding issues worth double-checking:
A postpartum visit sent without the TH modifier
A modifier added to a prenatal visit, which shouldn't have one
The birth billed as S9445 instead of 99199
A seventh prenatal or postpartum visit, past the 6-visit limit
Checking eligibility and claim status. NHP uses NaviNet, separate from Inovalon, for 24/7 member eligibility and claim status lookups. Check eligibility there before your first visit with a new client.
Disputing a decision. If a claim was processed and you disagree with the result, NHP's Claim Reconsideration Request form is on nhpri.org under Providers, then Provider Resources, then Forms.
If the reason isn't clear, or something about your contract or a member's coverage looks off, call NHP Provider Services at 1-800-963-1001.
Keep your visit notes, your session numbers, and your ERAs together in the client file. If you ever need to dispute a claim, that paper trail does the work for you.
The Short Version: NHP Billing at a Glance
What | Detail |
Before you bill | RICB CPD, active NPI, RI Medicaid enrollment, NHP credentialing approval in writing |
Claims tool | Inovalon Link1500, free for NHP providers |
Sign up | |
Time to portal access | About 2 weeks after the form |
Claim form | CMS 1500, manual entry |
Box 1 | Medicaid (RHE on the card is still NHP Medicaid) |
Taxonomy | 374J00000X (Doula) |
Prenatal | S9445, no modifier, Z33.1 |
Labor and delivery | 99199, no modifier, Z37.0 |
Postpartum | S9445 + TH, Z39.2 |
Visit limit | 6 prenatal and postpartum visits per member, combined, plus the birth |
Minimum visit length | 60 minutes |
Home births | Not covered (home prenatal and postpartum visits are) |
Diagnosis pointer (24E) | A, when there's one code |
Box 27 | YES (required for Medicaid) |
Medicaid payer ID | 05047 (for clearinghouses; in Inovalon, just pick Neighborhood) |
Filing deadline | 180 days from date of service (365 for corrected claims) |
Eligibility and claim status | NaviNet |
Claim screen timeout | About 20 minutes |
NHP Provider Services | 1-800-963-1001 |
A Note on What This Post Can and Can't Do
The steps here reflect how the Inovalon Link1500 portal and NHP billing worked as of November 2026, based on real claims experience. Codes, modifiers, and rates come from your own NHP contract, so check those first.
Payers update their policies, and portals change their screens. If something here doesn't match what you see, NHP Provider Services (1-800-963-1001) is the place to confirm.
If billing feels like more than you want to carry on your own, RI birth workers can join the RI Birthworker Coop for billing support. As of June 2026, membership was $100 a year, plus $60 a month for them to handle your billing.
This post is part of BirthPro's Business Basics series. Also in this series: Billing BCBSRI as a Doula | How to Apply for Your NPI Number | Taxonomy Codes and Billing Codes for Doulas | CAQH/DataSpring for Doulas | Sole Proprietor vs. LLC | What Doulas Can Write Off
