Assignment of PCP. The MCO must have written policies and procedures for assigning each of its members to a PCP. At the time of enrollment in the MCO, the enrollment broker will inquire as to the enrollee’s preference of PCPs (based on network information provided by the MCO). If such a preference is indicated during communications with the enrollment broker, this information will be collected as part of enrollment and included with the enrollment information given to BMS and the MCO. If no PCP selection is made, or if the selected PCP’s panel is closed, the MCO must assume responsibility for assisting the enrollee with PCP selection. MCOs must make a PCP assignment within ten (10) days after a Medicaid beneficiary is enrolled in the MCO. The process whereby MCOs assign PCPs to enrollees must take into consideration such known factors as current provider relationships, age and location of residence. The MCO then must notify the enrollee in writing of his or her PCP’s name, location and office telephone number, and the process for selecting a new PCP if the enrollee so desires. Members with a disabling condition, chronic illness or are SSI eligibles, must have a choice of specialist physician to serve as their PCP. The specialist physician must agree to perform all PCP duties required in the Contract and the PCP duties must be within the scope of the specialist’s license.
Assignment of PCP. The MCO must have written policies and procedures for assigning each of its members to a PCP. At the time of enrollment in the MCO, the enrollment broker will inquire as to the enrollee’s preference of PCPs (based on network information provided by the MCO). If such a preference is indicated during communications with the enrollment broker, this information will be collected as part of enrollment and included with the enrollment information given to BMS and the MCO. If no PCP selection is made, or if the selected PCP’s panel is closed, the MCO must assume responsibility for assisting the enrollee with PCP selection. MCOs must make a PCP assignment within 10 days after a Medicaid beneficiary is enrolled in the MCO. The process whereby MCOs assign PCPs to enrollees must take into consideration such known factors as current provider relationships and location of residence. The MCO then must notify the enrollee in writing of his or her PCP’s name, location and office telephone number, and the process for selecting a new PCP if the enrollee so desires.
Assignment of PCP. The MCO must have written policies and procedures for assigning each of its members to a PCP.
Assignment of PCP. The MCO must have written policies and procedures for assigning each of its enrollees to a PCP. The MCO will assume responsibility for assisting the enrollee with PCP selection. MCOs must make a PCP assignment within five (5) calendar days after a Medicaid beneficiary is enrolled in the MCO. The process whereby MCOs assign PCPs to enrollees must take into consideration such known factors as current provider relationships, age, the child’s placement (physical location), claims history, and input by DHHR caseworker. The MCO then must notify the enrollee or his representative in writing of his or her PCP’s name, location and office telephone number, and the process for selecting a new PCP if the enrollee so desires. Enrollees with a disabling condition, chronic illness or who are SSI eligibles, must have a choice of specialist physician to serve as their PCP. The specialist physician must agree to perform all PCP duties required in the Contract and the PCP duties must be within the scope of the specialist’s license.
Assignment of PCP. The MCO must have written policies and procedures for assigning each of its enrollees to a PCP. The MCO will assume responsibility for assisting the enrollee with PCP selection. MCOs must make a PCP assignment within five (5) calendar days after a Medicaid beneficiary is enrolled in the MCO. The process whereby MCOs assign PCPs to enrollees must take into consideration such known factors as current provider relationships, age, the child’s placement (physical location), claims history, and input by DHHR caseworker. The MCO then must notify the enrollee or his representative in writing of his or her PCP’s name, location and office telephone number, and the process for selecting a new PCP if the enrollee so desires. The MCO is required to confirm enrollees are aware of their PCP assignment and provide the opportunity to change their PCP assignment during the enrollee “welcome call” as defined in Article III, Section 4.5.1. Enrollees with a disabling condition, chronic illness or who are SSI eligibles, must have a choice of specialist physician to serve as their PCP. The specialist physician must agree to perform all PCP duties required in the Contract and the PCP duties must be within the scope of the specialist’s license.
