PCP Responsibilities Sample Clauses

PCP Responsibilities. The PCP will be the MCO enrollee’s initial and most important contact with the MCO. As such, PCPs must have at least the following responsibilities: • Maintaining continuity of each enrollee’s health care by serving as the enrollee’s primary care provider; • Providing twenty-four (24)-hour, seven (7)-day-a-week access; • Making referrals for specialty care and other Medically Necessary covered services, both in-network and out-of-network, consistent with the MCO’s utilization management policies; • Maintaining a current medical record for the enrollee, including documentation of all services provided to the enrollee by the PCP, as well as any specialty or referral services; • Adhering to the EPSDT Periodicity Schedule for enrollees under age twenty-one (21); and • Following MCO-established procedures for coordination of in-network and out-of- network services for Medicaid enrollees. Although PCPs must be given responsibility for the above activities, the MCO must also retain responsibility for monitoring PCP actions to ensure they comply with MCO and West Virginia Medicaid managed care program policies. Additionally, the MCO must communicate with PCPs about the delivery of primary behavioral health services within their scope of practice, as well as the appropriate circumstances for making referrals to behavioral health providers. MCOs may provide this information through its provider manual, continuing education agendas, informal visits by provider representatives, or any other means. The MCO must ensure that PCPs are successfully identifying and referring patients to a behavioral health provider and provide education to PCPs who do not have training in this area.
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PCP Responsibilities. In conformance with the Benefit Package, the PCP shall provide health counseling and advice; conduct baseline and periodic health examinations; diagnose and treat conditions not requiring the services of a specialist; arrange inpatient care, consultation with specialists, and laboratory and radiological services when medically necessary; coordinate the findings of consultants and laboratories; and interpret such findings to the Enrollee and the Enrollee's family, subject to the confidentiality provisions of Section 20 of this Agreement, and maintain a current medical record for the Enrollee. The PCP shall also be responsible for determining the urgency of a consultation with a specialist and shall arrange for all consultation appointments within appropriate time frames.
PCP Responsibilities. PCPs will be the MCO enrollee’s initial and most important contact with the Medicaid MCO. The PCPs’ responsibilities are outlined in Article III, Section 2.2 of the contract.
PCP Responsibilities. The Contractor shall require PCPs to meet the following requirements:
PCP Responsibilities. PCPs will be the MCO enrollee’s initial and most important contact with the Medicaid MCO. The PCPs’ responsibilities are outlined in Article III, Section 2.2 of the contract. According to West Virginia State Code 16-29 H-9, a patient-centered medical home is, “a health care setting that facilitates partnerships between individual patients and their personal physicians and, when appropriate, the patients’ families and communities. A patient-centered medical home integrates patients as active participants in their own health and well-being. Patients are cared for by a physician or physician practice that leads a multidisciplinary health team, which may include, but is not limited to, nurse practitioners, nurses, physician’s assistants, behavioral health providers, pharmacists, social workers, physical therapists, dental and eye care providers and dieticians to meet the needs of the patient in all aspects of preventive, acute, chronic care and end-of-life care using evidence-based medicine and technology. At the point in time that the Center for Medicare and Medicaid Services includes the nurse practitioner as a leader of the multidisciplinary health team, this state will automatically implement this change.”
PCP Responsibilities. Contractor agrees to have written policies and procedures for assigning every member to a Primary Care Provider (PCP), who has not chosen one at the time of enrollment. The PCP must serve as the member’s initial and most important point of interaction with the Health Plan network. As such, PCP responsibilities must include at a minimum: • Serving as the member’s Primary Care Provider (PCP) and medical home • Provide overall clinical direction and serve as the central point for the integration and coordination of care • Making referrals for specialty care and other Medically Necessary services, both in- and out-of-plan • Maintaining a current medical record for the member • Serve as the general care manager and refer members for specialized care management services, when appropriate Although PCPs must be given responsibility for the above activities, Contractor also agrees to retain responsibility for monitoring PCP actions to ensure they comply with Contractor and Rhode Island Medical Assistance managed care program policies.
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PCP Responsibilities. In conformance with the Benefit Package, the PCP shall provide health counseling and advice; conduct baseline and periodic health examinations; diagnose and treat conditions not requiring the services of a specialist; arrange inpatient care, consultation with specialists, and laboratory and radiological services when medically necessary; coordinate the findings of consultants and
PCP Responsibilities. PCPs will be the MCO enrollee’s initial and most important contact with the Medicaid MCO. The PCPs’ responsibilities are outlined in Article III, Section 2.2 of the contract. According to West Virginia State Code 16-29 H-9, a patient-centered medical home is, “a health care setting that facilitates partnerships between individual patients and their personal physicians and, when appropriate, the patients’ families and communities. A patient-centered medical home integrates patients as active participants in their own health and well-being. Patients are cared for by a physician or physician practice that leads a multidisciplinary health team, which may include, but is not limited to, nurse practitioners, nurses, physician’s assistants, behavioral
PCP Responsibilities. The PCP will be the MCO enrollee’s initial and most important contact with the MCO. As such, PCPs must have at least the following responsibilities:
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