PCP Assignment Sample Clauses
The PCP Assignment clause governs the conditions under which rights and obligations under a Primary Care Provider (PCP) agreement may be transferred from one party to another. Typically, this clause outlines whether either party can assign their interests in the contract to a third party, such as another healthcare provider or organization, and may specify requirements like obtaining prior written consent. Its core practical function is to control and clarify the process of assignment, thereby protecting both parties from unwanted transfers and ensuring continuity and stability in the contractual relationship.
PCP Assignment a. In the event that the Contractor is unable to elicit a PCP selection from an Enrollee, the Contractor shall promptly assign a PCP to each such Enrollee as described below. Such assignment shall be to the most appropriate PCP in accordance with this Contract and EOHHS policies and shall be effective no later than 15 days after the Effective Date of Enrollment in the Contractor’s Plan.
b. The Contractor shall, at a minimum, determine whether the assigned Enrollee has received services under the Contractor’s Plan within the previous year under MassHealth or a commercial membership.
1) If the assigned Enrollee was previously enrolled with the Contractor’s Plan, then the assignment shall be to the Enrollee’s most recent PCP if, in the Contractor’s reasonable judgment, such assignment is appropriate.
2) If the assigned Enrollee was not previously enrolled with the Contractor’s Plan, then the Contractor shall make its best efforts to seek and obtain pertinent information from the Enrollee to assign the Enrollee to an appropriate PCP, considering all sources of information available to the Contractor, including but not limited to, information provided by EOHHS or its CSC Enrollment Vendor. The Contractor shall, based on such information that it is able to obtain in a timely manner, take into account factors that include, but are not limited to, the following:
a) Available information on the Enrollee’s health care needs, including Behavioral Health Services needs;
b) PCP training and expertise with demographic or special populations similar to the Enrollee, including children in the care or custody of DCF or youth affiliated with DYS (either detained or committed) and homeless persons;
c) Geographical proximity of PCP site(s) to the Enrollee’s residence;
d) Whether the PCP site is accessible by public transportation;
e) Whether the PCP site is accessible to people with disabilities;
f) The Enrollee’s preferred language and capabilities of the PCP to practice in that language; and
g) Access to skilled medical interpreters who speak the Enrollee’s preferred language at the PCP site.
c. The Contractor shall inform the Enrollee of the name of the PCP to whom he or she is assigned and offer to assist the Enrollee in scheduling an initial appointment with the PCP.
d. The Contractor shall routinely and promptly inform PCPs of newly assigned Enrollees and shall require PCPs to make best efforts to schedule an initial appointment with new Enrollees.
e. The Contractor sha...
PCP Assignment. 2.10.4.1. The Contractor will allow each Enrollee to choose his or her PCP to the extent possible and appropriate. If the Enrollee does not select a PCP within thirty (30) calendar days of the effective coverage date, Contractor shall assign that Enrollee to a PCP and notify the Enrollee and the assigned PCP in writing no later than forty (40) calendar days after the Enrollee’s coverage date.
2.10.4.2. If an Enrollee does not select a PCP within thirty (30) calendar days of the effective date of coverage date, Contractor shall use FFS utilization data or other data sources, including electronic data, to:
2.10.4.2.1. Establish existing provider relationships for the purpose of PCP assignment, including a specialist or clinic, if an Enrollee indicates a preference for either. Contractor shall comply with all federal and state privacy laws in the provision and use of this data.
2.10.4.3. Contractor shall notify the PCP that an Enrollee has selected or been assigned to the PCP within ten (10) calendar days from when selection or assignment is completed by the Enrollee or the Contractor, respectively.
2.10.4.4. Contractor shall maintain procedures that proportionately include contracting traditional and safety-net providers in the assignment process for Enrollees who do not choose a PCP.
2.10.4.5. If, at any time, an Enrollee notifies the Contractor of a PCP choice, such choice shall override Enrollee assignment to a PCP in accordance with applicable DPL(s) as indicated in Section 2.1.5.
PCP Assignment. 2.10.4.1. If the Enrollee does not select a PCP within thirty (30) calendar days of the effective coverage date, Contractor shall assign that Enrollee to a PCP and notify the Enrollee and the assigned PCP in writing no later than forty (40) calendar days after the Enrollee’s coverage date.
2.10.4.2. If an Enrollee does not select a PCP within thirty (30) calendar days of the effective date of coverage date, Contractor shall use FFS utilization data or other data sources, including electronic data, to:
2.10.4.2.1. Establish existing provider relationships for the purpose of PCP assignment, including a specialist or clinic if an Enrollee indicates a preference for either. Contractor shall comply with all federal and state privacy laws in the provision and use of this data.
2.10.4.3. Contractor shall notify the PCP that an Enrollee has selected or been assigned to the PCP within ten (10) calendar days from when selection or assignment is completed by the Enrollee or the Contractor, respectively.
2.10.4.4. Contractor shall maintain procedures that proportionately include contracting traditional and safety-net providers in the assignment process for Enrollees who do not choose a PCP.
2.10.4.5. If, at any time, an Enrollee notifies the Contractor of a PCP choice, such choice shall override Enrollee assignment to a PCP.
PCP Assignment. If the contractor has not received an enrollee's PCP selection within ten (10) calendar days from the enrollee's effective date of coverage or the selected PCP's panel is closed, the contractor shall assign a PCP and deliver an ID card by the fifteenth (15th) calendar day after the effective date of enrollment. The assignment shall be made according to the following criteria, in hierarchical order:
1. The enrollee shall be assigned to his/her current provider, if known, as long as that provider is a part of the contractor's provider network.
2. The enrollee shall be assigned to a PCP whose office is within the travel time/distance standards, as defined in Article 4.8.
PCP Assignment. The term “PCP Assignment” refers to the process by which an Member is assigned by HPSM to a PCP for provision of certain Covered Services, or to the PCP assigned for a particular Member.
PCP Assignment. If the contractor has not received an enrollee's PCP selection within ten (10) calendar days from the enrollee's effective date of coverage or the selected PCP's panel is closed, the contractor shall assign a PCP and deliver an ID card by the fifteenth (15th) calendar day after the effective date of enrollment. The assignment shall be made according to the following criteria, in hierarchical order:
1. The enrollee shall be assigned to his/her current provider, if known, as long as that provider is a part of the contractor's provider network.
2. The enrollee shall be assigned to a PCP whose office is within the travel time/distance standards, as defined in Article 4.8.8. If the language and/or cultural needs of the enrollee are known to the contractor, the enrollee shall be assigned to a PCP who is or has office staff who are linguistically and culturally competent to communicate with the enrollee or have the ability to interpret in the provision of health care services and related activities during the enrollee's office visits or contacts.
PCP Assignment. If the contractor has not received an enrollee’s PCP selection within ten (10) calendar days from the enrollee’s effective date of coverage or the selected PCP’s panel is closed, the contractor shall assign a PCP and deliver an ID card by the fifteenth (15th) calendar day after the effective date of enrollment. The assignment shall be made according to the following criteria, in hierarchical order:
PCP Assignment. Provider Network...............................................................................
PCP Assignment. The CHC-MCO must provide a file through the Department to (PROMISe™) of PCP assignments for all its Participants. The CHC-MCO must provide this file at least weekly or more frequently if requested by the Department. The CHC-MCO must ensure that the PCP assignment information is consistent with all requirements specified by the Department by utilizing the response report provided by the Department. The CHC-MCO must use this report to reconcile and correct any errors. Information on the PCP file submission is available on the Intranet supporting CHC.