Medical billing concept - Patient 1st plan

Patient 1st

Patient 1st is a statewide Primary Care Case Management (PCCM) system. Medicaid recipients eligible for this program are assigned to a Primary Medical Provider (PMP) who is responsible for primary care services and authorization of referrals.

The eligibility response from AVRS or Provider Electronic Solutions provides the following information if the recipient is enrolled in Patient 1st: Verification of the recipient’s enrollment in Patient 1st

• PMP’s NPI
• PMP’s telephone number (and 24-hour phone number, if applicable)
• Effective and End Dates of enrollment

The PMP must be contacted to authorize any service requiring a referral. Chapter 39, Patient 1st, provides information on referrals. Once the referral is obtained, the claim is filed directly to HP for processing

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