For Providers

As central stakeholders in Rhode Island's health insurance system, providers supply OHIC with crucial input on everything from policy development to insurers' day-to-day conduct. Below you will find information on how OHIC’s Affordability Standards affect providers and a range of ways to join the conversation and make your voices heard.

OHIC’s Affordability Standards: Patient-Centered Medical Home (PCMH) Provider Reporting

OHIC's affordability initiatives have emphasized the need for a strong primary care infrastructure and since 2011, OHIC has been promoting PCMH transformation to help strengthen Rhode Island's primary care network. In 2015, OHIC worked with its Care Transformation Advisory Committee to define patient-centered medical homes and to set a year over year target for PCMH adoption. Insurers subject to OHIC's Affordability Standards are required to have 80% of their contracted clinicians operating in a PCMH by the end of 2019.

This three part definition of PCMH requires demonstration of practice transformation, implementation of cost management initiatives, and clinical improvment. This definition of a PCMH also includes a provider reporting component.

PCMH Provider Reporting Submission Information

Join the Discussion

OHIC has started an extensive conversation about healthcare reform in Rhode Island and it wants providers to participate. Learn more about OHIC's reform initiatives and conversations in Reform and Policy.

Resolve an Issue or File a Complaint

Healthcare providers should review their health plan contracts and administrative policies on appeals before filing a complaint. Providers should also contact the relevant insurance companies and attempt to resolve the issue through discussion and negotiation before contacting OHIC.

For additional assistance, please visit OHIC's customer assistance partner: RI Reach or call toll-free at 1-(855)-747-3224

OHIC Complaint Form