PCP provider responsibility - Prestige health choice

16. The provider agrees to participate in and cooperate with
Prestige Health Choice’s grievance and appeal procedures
when Prestige Health Choice notifies the provider
of any member complaints or grievances.

17. Balance billing for a covered service is not permitted.

18. A member can only be billed for applicable copayments,
if the copayment was not collected at the time the
service was rendered.

19. In the event that a provider’s agreement with Prestige
Health Choice is terminated, the provider must continue
care in progress during and after the termination
period for up to six months until a provision is made by
Prestige Health Choice for the reassignment of members.
Pregnant members can continue receiving services
through postpartum care. Payment for covered services
under this continuity of care period will be made in accordance
with the rates effective in the provider’s participating
agreement at the time of termination.

20. PCPs are required to maintain malpractice insurance
acceptable to Prestige Health Choice, which will protect
the PCP and his/her employees. This information is verified
by obtaining a copy of the malpractice insurance fact
sheet from the PCP or from the malpractice insurance
carrier. If not carrying malpractice insurance (“going
bare”) the PCP must conform to the notification requirements
contained in Section 458.320, F.S.

21. The provider must comply with all applicable federal
and state laws regarding the confidentiality of member
records.

22. The provider agrees to develop and have an exposure
control plan in compliance with OSHA standards regarding
blood borne pathogens.

23. The provider agrees to establish appropriate policies and
procedures to fulfill obligations under the Americans with
Disabilities Act (ADA).

24. The provider agrees to support and cooperate with
Prestige Health Choice’s Quality Management Program
to provide quality care in a responsible and cost-effective
manner.

25. The PCP agrees to provide HIV counseling and offer HIV
testing to all members of childbearing age.

26. The PCP agrees to refer pregnant women or infants to
Healthy Start and WIC programs.

27. The PCP agrees to provide counseling and education in
support of Medicaid Quality and Benefit Enhancement
(QBE) services which include: children’s programs, domestic
violence, pregnancy prevention (including abstinence),
prenatal/postpartum care, smoking cessation and
substance abuse. The PCP agrees to include information
on the programs and community resources encouraged
by Prestige Health Choice.

28. The PCP agrees to provide counseling and offer the
recommended anti-retroviral regimen to all pregnant
women who are HIV-positive and to refer them and their
infants to Healthy Start programs, regardless of their
screening scores.

29. The PCP agrees to offer screening for Hepatitis B surface
antigen to all women receiving prenatal care. If they
test positive, the PCP agrees to refer them to Healthy
Start regardless of their screening score and to provide
Hepatitis B Immune Globulin and the Hepatitis B vaccine
series to children born to such mothers.

30. The provider agrees to inform Prestige Health Choice if
he/she objects to the provision of any counseling, treatments
or referral services on religious grounds.

31. The provider agrees to treat all members with respect
and dignity, to provide them with appropriate privacy,
and to treat member disclosures and records confidentially,
giving the members the opportunity to approve or
refuse their release in accordance with HIPAA and applicable
state laws.

32. The provider agrees to provide to the members complete
information concerning their diagnosis, evaluation, treatment
and prognosis, and to give members the opportunity
to participate in decisions involving their healthcare,
regardless of whether the member has completed an
advance directive, except when contraindicated for medical
reasons.

33. The provider agrees to an adequate and timely communication
among providers and the transfer of information
when members are transferred to other healthcare
providers.

34. The provider agrees to obtain a signed and dated release
allowing for the release of information to Prestige Health
Choice and other providers involved in the member’s
care.

35. The PCP agrees to physically screen members taken into
the Protective Custody, Emergency Shelter or Foster Care
programs by the Department of Children and Families
(DCF) within 72 hours or immediately, if required.

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