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Woman And Infants
Woman And Infants

Payer Credentialing/CAQH Support Services

Payer Credentialing
The PHO offers all the credentialing & re-credentialing services needed to manage the complex task of payer credentialing. Our PHO is uniquely qualified to provide you valuable support and guidance as you navigate the minefields of payer credentialing. PHO keeps you informed of your credentialing process every step of the way.

Payers we work with, contacts and phone numbers:

Aetna Karen Dumez 860-636-8956
Blue Cross Blue Shield of RI Roberta Salvas 401-459-5640
Colonial Cooperative Care
EDS/Medicaid Dianne Folco
Barbara Lynch
First Health/Coventry Healthcare Kimberly Hughes 781-762-5511 x211
Great West
Rebecca Brown
Matthew Bancroft
888-244-6264 x76461
Harvard Pilgrim HealthCare Jammie Carty 800-708-4414
Health Net Call Center 203-225-3921
Health Net Federal (Tricare)
Medicare Sharleen Campbell 781-741-3221
Cindy Gisono
Sandra Caucci
Neighborhood Health Plan of RI Lisa Caton 401-459-6182
Tufts Health Plan
Christopher Saris
Mike Kerble
888-306-6307 x9717
888-306-6307 x9812
UnitedHealthcare Janine Forrest 401-732-7296
Various Behavioral Health Plans

MA & CT third-party payers

For all your Credentialing & Recredentialing questions,
call the PHO office at 274-1122 extension 2012

Council for Affordable Quality Healthcare (CAQH)
The PHO serves as a co-chair for the CAQH National User Group Forum.

CAQH continues to annually recognize our PHOs as a centralized, payer credentialing service "National Leader" regarding CAQH training and adoption with physician practices.

CAQH, an unprecedented nonprofit alliance of health plans and trade associations, is a catalyst for industry collaboration on initiatives that simplify healthcare administration. CAQH solutions promote quality interactions between plans, providers and other stakeholders; reduce costs and frustrations associated with healthcare administration; facilitate administrative healthcare information exchange and encourage administrative and clinical data integration.

The PHO extends our CAQH Services (CAQH & Payer Credentialing Brochure) to all medical professionals (employed & community). Simply complete the CAQH Data request form, attach the requested documents and mail to:

Attn: Jacki DeCesare
Women & Infants PHO, Inc.
101 Dudley Street
Providence, RI 02905

For all your CAQH questions, call Jacki DeCesare at (401) 274-1122 extension 2077 or
e-mail jdecesare@wihri.org

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